The Experts below are selected from a list of 1281 Experts worldwide ranked by ideXlab platform

Francois Singelyn - One of the best experts on this subject based on the ideXlab platform.

  • unintentional Neuromuscular Blocking Agent injection during an axillary brachial plexus nerve block
    Regional Anesthesia and Pain Medicine, 2005
    Co-Authors: Regis Fuzier, Francois Singelyn
    Abstract:

    OBJECTIVE: We describe the consequences of an unintentional injection of atracurium instead of ropivacaine during an axillary brachial plexus nerve block. CASE REPORT: A 79-year-old woman was scheduled for wrist fracture repair. An axillary brachial plexus block was performed by use of a nerve stimulator. Twenty milliliters of 0.5% ropivacaine with 1:200,000 epinephrine was injected on the radial and then on the median nerves. Two minutes later, the patient became dyspneic and was unable to elevate her head from the pillow. A check of the syringes revealed that one contained 50 mg of atracurium instead of 0.5% ropivacaine. After IV propofol was administered, the trachea was intubated and controlled ventilation started. At the end of surgery (more than 2 hours later), reversal of residual Neuromuscular block was performed. The motor and sensory brachial plexus block completely recovered 12 hours after the initial bolus injection. No clinical neurological deficit was reported afterward by the patient. CONCLUSIONS: Unintentional injection of atracurium mixed with ropivacaine during axillary brachial plexus block leads to complete body paralysis that requires general anesthesia and mechanical ventilation. Recovery was complete without any neurological sequela. An analysis of the chain of events that led to the error suggests some recommendations to improve our daily practice.

  • unintentional Neuromuscular Blocking Agent injection during an axillary brachial plexus nerve block
    Regional Anesthesia and Pain Medicine, 2005
    Co-Authors: Regis Fuzier, Francois Singelyn
    Abstract:

    OBJECTIVE: We describe the consequences of an unintentional injection of atracurium instead of ropivacaine during an axillary brachial plexus nerve block. CASE REPORT: A 79-year-old woman was scheduled for wrist fracture repair. An axillary brachial plexus block was performed by use of a nerve stimulator. Twenty milliliters of 0.5% ropivacaine with 1:200,000 epinephrine was injected on the radial and then on the median nerves. Two minutes later, the patient became dyspneic and was unable to elevate her head from the pillow. A check of the syringes revealed that one contained 50 mg of atracurium instead of 0.5% ropivacaine. After IV propofol was administered, the trachea was intubated and controlled ventilation started. At the end of surgery (more than 2 hours later), reversal of residual Neuromuscular block was performed. The motor and sensory brachial plexus block completely recovered 12 hours after the initial bolus injection. No clinical neurological deficit was reported afterward by the patient. CONCLUSIONS: Unintentional injection of atracurium mixed with ropivacaine during axillary brachial plexus block leads to complete body paralysis that requires general anesthesia and mechanical ventilation. Recovery was complete without any neurological sequela. An analysis of the chain of events that led to the error suggests some recommendations to improve our daily practice.

S Agoston - One of the best experts on this subject based on the ideXlab platform.

  • PROLONGATION BY BILE SALTS OF THE DURATION OF ACTION OF A STEROIDAL Neuromuscular Blocking Agent
    2016
    Co-Authors: R. J. Vonk, P. Westra, M. C. Houwertjes, S Agoston
    Abstract:

    The influence of bile salts on the duration of action of the steroidal non-depolarizing Neuromuscular Blocking Agent ORG 6368 was investigated in cats. The intravenous administration of ORG 6368 (100 ng/kg body wt) caused a maximum Neuromuscular blockade of 71 +6 % with a duration of action of 3.4 + 0.1 min. However, intraportal administration of the same dose caused no significant Neuromuscular blockade. Following an infusion of dehydrocholate 320 [imol, lasting for 8 min, the magnitude and the duration of action of the Neuromuscular blockade produced by ORG 6368 were increased markedly. This effect of the bile salt is possibly a result of inhibition of the hepatic uptake of ORG 6368, thereby retarding its disappearance from the plasma and consequently pro-longing the Neuromuscular blockade. The Neuromuscular Blocking effect of intraportally administered gallamine (1 mg/kg body wt) was not influenced significantly by the infusion of dehydrocholate. The durations of action of Neuromuscular Blocking Agents are determined by a number of factors including drug-receptor interactions, possible cholinesterase inhibition by the relaxant drug (Foldes, 1971,1975— personal communications; Schuh, 1977) and their pharmacokinetic behaviour. In particular, renal an

  • clinical pharmacology of org 7617 a short acting non depolarizing Neuromuscular Blocking Agent
    European Journal of Clinical Pharmacology, 1994
    Co-Authors: L Van Den Broek, J M K H Wierda, Johannes H Proost, F D M Hommes, S Agoston
    Abstract:

    The dose-response relationship and the time course of action of Org 7617, a short acting non-depolarizing Neuromuscular Blocking Agent, were evaluated during thiopentone, fentanyl, halothane and N2O anaesthesia. Neuromuscular transmission was monitored mechanomyographically. The ED50 and ED90 were calculated after single bolus doses of the drug. Twelve, seven and three patients received 2.5, 3.75 or 5.0 mg · kg−1 Org 7617, respectively. Neuromuscular block was characterized by a short lag time (average 30 s) and rapid development of Neuromuscular block (69–84 s).

  • clinical pharmacology of org 7617 a short acting non depolarizing Neuromuscular Blocking Agent
    European Journal of Clinical Pharmacology, 1994
    Co-Authors: L Van Den Broek, J M K H Wierda, Johannes H Proost, F D M Hommes, S Agoston
    Abstract:

    The dose-response relationship and the time course of action of Org 7617, a short acting non-depolarizing Neuromuscular Blocking Agent, were evaluated during thiopentone, fentanyl, halothane and N2O anaesthesia. Neuromuscular transmission was monitored mechanomyographically. The ED50 and ED90 were calculated after single bolus doses of the drug. Twelve, seven and three patients received 2.5, 3.75 or 5.0 mg · kg−1 Org 7617, respectively. Neuromuscular block was characterized by a short lag time (average 30 s) and rapid development of Neuromuscular block (69–84 s). Maximum block approximated to 66%, 91% and 95%, and the duration until clinically adequate recovery (TOF ratio of 0.7) to 7.4, 12.1 and 12.2 min after 2.5, 3.75, 5 mg · kg−1 of Org 7617, respectively. The calculated ED50 and ED90 were 1.8 and 3.4 mg · kg−1. Adverse effects, including a moderate fall in systolic and diastolic arterial blood pressure and a concomitant increase in heart rate appeared to be dose-dependent. Some patients showed flushing. One patient given 5 mg/kg Org 7617 had serious adverse effects suggestive of histamine release, i.e. flushing, urticaria, tachycardia, hypotension and bronchospasm. Therefore further clinical investigations were terminated. Although its low potency and the adverse effects observed will prevent further clinical development of ORG 7617, the results do support the contention that it is feasible to develop short-acting non-depolarizing Neuromuscular Blocking Agents from the steroidal series.

  • the pharmacodynamics and pharmacokinetics of org 9426 a new non depolarizing Neuromuscular Blocking Agent in patients anaesthetized with nitrous oxide halothane and fentanyl
    Canadian Journal of Anaesthesia-journal Canadien D Anesthesie, 1991
    Co-Authors: J M K H Wierda, L M Lambalk, U W Kleef, Wybe D Kloppenburg, S Agoston
    Abstract:

    The pharmacodynamics and pharmacokinetics of a new non-depolarizing Neuromuscular Blocking Agent, Org 9426, were investigated. Ten patients undergoing elective head and neck surgery and anaesthetized with nitrous oxide, halothane and fentanyl, received a bolus dose of Org 9426 (1 mg.kg-1, 3 x ED90). The isometric contractions of the adductor pollicis muscle following ulnar nerve stimulation (0.1 Hz and intermittent TOF) were measured. Blood and urine were sampled over 8 and 24 hr, respectively. Concentrations of Org 9426 and its possible metabolites in plasma and urine were determined using HPLC. Pharmacokinetic variables were calculated by iterative linear least square regression analysis. Intubation conditions were excellent one minute after administration at a Neuromuscular block of 88 (13)% (Mean (CV]. Onset time until maximum block, duration until 25% recovery of twitch height, and recovery from 25 until 75% of twitch height were 1.7 (32), 53 (19) and 20 (37) min, respectively. The TOF reached a ratio of 0.7 after 87 (19) min. Half lives were 1.8 (33), 19 (34), 131 (62) min, respectively, in a three exponential decay; distribution volume at steady-state and plasma clearance were 0.264 (56) L.kg-1 and 4.0 (21) ml.kg-1.min-1, respectively. Plasma concentration at 25% recovery of the twitch height was 1.0 mg.L-1. Within 24 h, 33 (37)% of Org 9426 was excreted unchanged in the urine. Metabolites were absent both in plasma and urine. We conclude that the difference in potency between Org 9426 and vecuronium is similar to the difference between their effective concentrations.(ABSTRACT TRUNCATED AT 250 WORDS)

  • the pharmacodynamics and pharmacokinetics of org 9426 a new non depolarizing Neuromuscular Blocking Agent in patients anaesthetized with nitrous oxide halothane and fentanyl
    Canadian Journal of Anaesthesia-journal Canadien D Anesthesie, 1991
    Co-Authors: J M K H Wierda, L M Lambalk, U W Kleef, Wybe D Kloppenburg, S Agoston
    Abstract:

    The pharmacodynamics and pharmacokinetics of a new non-depolarizing Neuromuscular Blocking Agent, Org 9426, were investigated. Ten patients undergoing elective head and neck surgery and anaesthetized with nitrous oxide, halothane and fentanyl, received a bolus dose of Org 9426 (I mg · kg−1, 3 × ED90). The isometric contractions of the adductor pollids muscle following ulnar nerve stimulation (0.1 Hz and intermittent TOF) were measured. Blood and urine were sampled over 8 and 24 hr, respectively. Concentrations of Org 9426 and its possible metabolites in plasma and urine were determined using HPLC. Pharmacokinelic variables were calculated by iterative linear least square regression analysis. Intubation conditions were excellent one minute after administration at a neuro-muscular block of 88 (13)% (Mean (CV)). Onset time until maximum block, duration until 25% recovery of twitch height, and recovery from 25 until 75% of twitch height were 1.7 (32), 53 (19) and 20 (37) min, respectively. The TOF reached a ratio of 0.7 after 87 (19) min. Half lives were 1.8(33), 19(34), 131 (62) min, respectively, in a three exponential decay; distribution volume at steady-state and plasma clearance were 0.264 (56) L · kg− 1 and 4.0 (21) ml · kg− 1 · min− 1, respectively. Plasma concentration at 25% recover)1 of the twitch height was 1.0 mg · L− 1. Within 24 h, 33 (37)% of Org 9426 was excreted unchanged in the urine. Metabolites were absent both in plasma and urine. We conclude that the difference in potency between Org 9426 and vecuronium is similar to the difference between their effective concentrations. Org 9426 mimics vecuronium in its time-course of action and pharmacokinetic behaviour and produces excellent intubaling conditions one minute following the administration of I mg · kg− 1.

Regis Fuzier - One of the best experts on this subject based on the ideXlab platform.

  • unintentional Neuromuscular Blocking Agent injection during an axillary brachial plexus nerve block
    Regional Anesthesia and Pain Medicine, 2005
    Co-Authors: Regis Fuzier, Francois Singelyn
    Abstract:

    OBJECTIVE: We describe the consequences of an unintentional injection of atracurium instead of ropivacaine during an axillary brachial plexus nerve block. CASE REPORT: A 79-year-old woman was scheduled for wrist fracture repair. An axillary brachial plexus block was performed by use of a nerve stimulator. Twenty milliliters of 0.5% ropivacaine with 1:200,000 epinephrine was injected on the radial and then on the median nerves. Two minutes later, the patient became dyspneic and was unable to elevate her head from the pillow. A check of the syringes revealed that one contained 50 mg of atracurium instead of 0.5% ropivacaine. After IV propofol was administered, the trachea was intubated and controlled ventilation started. At the end of surgery (more than 2 hours later), reversal of residual Neuromuscular block was performed. The motor and sensory brachial plexus block completely recovered 12 hours after the initial bolus injection. No clinical neurological deficit was reported afterward by the patient. CONCLUSIONS: Unintentional injection of atracurium mixed with ropivacaine during axillary brachial plexus block leads to complete body paralysis that requires general anesthesia and mechanical ventilation. Recovery was complete without any neurological sequela. An analysis of the chain of events that led to the error suggests some recommendations to improve our daily practice.

  • unintentional Neuromuscular Blocking Agent injection during an axillary brachial plexus nerve block
    Regional Anesthesia and Pain Medicine, 2005
    Co-Authors: Regis Fuzier, Francois Singelyn
    Abstract:

    OBJECTIVE: We describe the consequences of an unintentional injection of atracurium instead of ropivacaine during an axillary brachial plexus nerve block. CASE REPORT: A 79-year-old woman was scheduled for wrist fracture repair. An axillary brachial plexus block was performed by use of a nerve stimulator. Twenty milliliters of 0.5% ropivacaine with 1:200,000 epinephrine was injected on the radial and then on the median nerves. Two minutes later, the patient became dyspneic and was unable to elevate her head from the pillow. A check of the syringes revealed that one contained 50 mg of atracurium instead of 0.5% ropivacaine. After IV propofol was administered, the trachea was intubated and controlled ventilation started. At the end of surgery (more than 2 hours later), reversal of residual Neuromuscular block was performed. The motor and sensory brachial plexus block completely recovered 12 hours after the initial bolus injection. No clinical neurological deficit was reported afterward by the patient. CONCLUSIONS: Unintentional injection of atracurium mixed with ropivacaine during axillary brachial plexus block leads to complete body paralysis that requires general anesthesia and mechanical ventilation. Recovery was complete without any neurological sequela. An analysis of the chain of events that led to the error suggests some recommendations to improve our daily practice.

Abdulaziz A Aljafari - One of the best experts on this subject based on the ideXlab platform.

  • the inhibitory effect of the Neuromuscular Blocking Agent gallamine triethiodide on camel retina acetylcholinesterase activity
    Toxicology Letters, 1997
    Co-Authors: Abdulaziz A Aljafari
    Abstract:

    Abstract The present investigation addresses the mode of inhibition of the camel retinal acetylcholinesterase (AChE) activity by gallamine triethiodide, which is known to be a specific non-depolarizing Neuromuscular Blocking Agent and polar cholinergic antagonist. This study gave the following results: it was found that gallamine (GA) reversibly inhibited the AChE activity in a concentration dependent manner, the IC5o being about 0.633 mM. The Km for the hydrolysis of acetylthiocholine iodide by AChE was found to be 0.0803 mM in the control system, and the value increased by 19–463% in the GA (0.125–1.0 mM) treated systems. The Vmax was 0.649 μmol/min per mg protein for the control as well as GA treated systems. Dixon as well as Lineweaver-Burk plots and their secondary replots indicated that the nature of the inhibition is of the reversible competitive type. The Ki, value was estimated as 0.160 mM. The Ki, value increased with an increase in substrate concentration. The turnover number (cat) and specificity constant (Ksp) were 62.1 min-1 and 7.73 x 105 (M-min)-1 in the control system while the value for one parameter (Agp) was decreased by 25–83% in the GA (0.125–1.0 mM) treated systems

  • the inhibitory effect of the Neuromuscular Blocking Agent gallamine triethiodide on camel retina acetylcholinesterase activity
    Toxicology Letters, 1997
    Co-Authors: Abdulaziz A Aljafari
    Abstract:

    Abstract The present investigation addresses the mode of inhibition of the camel retinal acetylcholinesterase (AChE) activity by gallamine triethiodide, which is known to be a specific non-depolarizing Neuromuscular Blocking Agent and polar cholinergic antagonist. This study gave the following results: it was found that gallamine (GA) reversibly inhibited the AChE activity in a concentration dependent manner, the IC5o being about 0.633 mM. The Km for the hydrolysis of acetylthiocholine iodide by AChE was found to be 0.0803 mM in the control system, and the value increased by 19–463% in the GA (0.125–1.0 mM) treated systems. The Vmax was 0.649 μmol/min per mg protein for the control as well as GA treated systems. Dixon as well as Lineweaver-Burk plots and their secondary replots indicated that the nature of the inhibition is of the reversible competitive type. The Ki, value was estimated as 0.160 mM. The Ki, value increased with an increase in substrate concentration. The turnover number (cat) and specificity constant (Ksp) were 62.1 min-1 and 7.73 x 105 (M-min)-1 in the control system while the value for one parameter (Agp) was decreased by 25–83% in the GA (0.125–1.0 mM) treated systems

J M K H Wierda - One of the best experts on this subject based on the ideXlab platform.

  • pharmacodynamics and pharmacokinetics of an infusion of org 9487 a new short acting steroidal Neuromuscular Blocking Agent
    BJA: British Journal of Anaesthesia, 1994
    Co-Authors: L Van Den Broek, J M K H Wierda, N J Smeulers, Johannes H Proost
    Abstract:

    We have evaluated in 10 anaesthetized patients the time course of action, infusion requirements, reversibility and pharmacokinetics of Org 9487. Org 9487 was administered as a bolus dose of 1.5 mg kg−1 followed by an infusion to maintain a block of 75–85% for 60 min. After recovery from the bolus dose, a mean dose of Org 9487 3.4 (SD 1.0) mg kg−1 h−1 was administered to maintain a mean Neuromuscular block of 83 (3)%. During the final 15 min of infusion, the infusion requirements were 2.5 (1.1) mg kg−1 h−1 In the five patients who were allowed to recover spontaneously, a TOF ratio of 0.7 was reached 37.9 (12.4) min after stopping the infusion of Org 9487. In the five patients who received neostigmine, a TOF ratio of 0.7 was reached after 14.5 (6.1) min. Plasma clearance was 8.5 (30%) ml kg−1 min−1. Volume of distribution at steady state was 293 (55%) ml kg−1 Terminal half life and mean residence time were 71.7 (34%) and 33.4 (31%) min, respectively. The concentration of the 3-OH metabolite remained relatively low. Urinary excretion of Org 9487 and its metabolites was 22% in 24 h. In conclusion, a 1-h infusion of the short-acting drug Org 9487 changed its time course characteristics gradually from that of a short-acting Neuromuscular Blocking Agent to that of a Neuromuscular blocker with an intermediate duration of action.

  • clinical pharmacology of org 7617 a short acting non depolarizing Neuromuscular Blocking Agent
    European Journal of Clinical Pharmacology, 1994
    Co-Authors: L Van Den Broek, J M K H Wierda, Johannes H Proost, F D M Hommes, S Agoston
    Abstract:

    The dose-response relationship and the time course of action of Org 7617, a short acting non-depolarizing Neuromuscular Blocking Agent, were evaluated during thiopentone, fentanyl, halothane and N2O anaesthesia. Neuromuscular transmission was monitored mechanomyographically. The ED50 and ED90 were calculated after single bolus doses of the drug. Twelve, seven and three patients received 2.5, 3.75 or 5.0 mg · kg−1 Org 7617, respectively. Neuromuscular block was characterized by a short lag time (average 30 s) and rapid development of Neuromuscular block (69–84 s).

  • clinical pharmacology of org 7617 a short acting non depolarizing Neuromuscular Blocking Agent
    European Journal of Clinical Pharmacology, 1994
    Co-Authors: L Van Den Broek, J M K H Wierda, Johannes H Proost, F D M Hommes, S Agoston
    Abstract:

    The dose-response relationship and the time course of action of Org 7617, a short acting non-depolarizing Neuromuscular Blocking Agent, were evaluated during thiopentone, fentanyl, halothane and N2O anaesthesia. Neuromuscular transmission was monitored mechanomyographically. The ED50 and ED90 were calculated after single bolus doses of the drug. Twelve, seven and three patients received 2.5, 3.75 or 5.0 mg · kg−1 Org 7617, respectively. Neuromuscular block was characterized by a short lag time (average 30 s) and rapid development of Neuromuscular block (69–84 s). Maximum block approximated to 66%, 91% and 95%, and the duration until clinically adequate recovery (TOF ratio of 0.7) to 7.4, 12.1 and 12.2 min after 2.5, 3.75, 5 mg · kg−1 of Org 7617, respectively. The calculated ED50 and ED90 were 1.8 and 3.4 mg · kg−1. Adverse effects, including a moderate fall in systolic and diastolic arterial blood pressure and a concomitant increase in heart rate appeared to be dose-dependent. Some patients showed flushing. One patient given 5 mg/kg Org 7617 had serious adverse effects suggestive of histamine release, i.e. flushing, urticaria, tachycardia, hypotension and bronchospasm. Therefore further clinical investigations were terminated. Although its low potency and the adverse effects observed will prevent further clinical development of ORG 7617, the results do support the contention that it is feasible to develop short-acting non-depolarizing Neuromuscular Blocking Agents from the steroidal series.

  • dose response relation Neuromuscular Blocking action intubation conditions and cardiovascular effects of org 9273 a new Neuromuscular Blocking Agent
    Anesthesia & Analgesia, 1991
    Co-Authors: L Van Den Broek, L M Lambalk, F J Richardson, J M K H Wierda
    Abstract:

    The ED50 and the ED90, the time-course of the Neuromuscular block, the intubation conditions, and the cardiovascular effects of Org 9273, a new steroidal nondepolarizing Neuromuscular Blocking Agent, have been evaluated in 41 anesthetized patients. From cumulative dose-response curves the ED50 and ED90 were calculated to be 175 and 300 micrograms/kg, respectively. The time-course of Neuromuscular blockade after 300- and 500-micrograms/kg doses of Org 9273 appeared to be similar to that of equipotent doses of vecuronium. The Neuromuscular block was characterized by a fast initial rate of block development. High-dose Org 9273 (1 mg/kg = 3-4 times the ED90) had a clinical duration comparable to an intubating dose of pancuronium, but a considerably more rapid onset and recovery index. Three hundred micrograms per kilogram and 500 micrograms/kg Org 9273 produced good to excellent intubation conditions 1 min after administration. Org 9273 in a dose of 0.5-2 times the ED90 produced no cardiovascular changes; however, 3-4 times the ED90 increased heart rate 20%-25% (P less than 0.001), probably due to a vagolytic effect.

  • the pharmacodynamics and pharmacokinetics of org 9426 a new non depolarizing Neuromuscular Blocking Agent in patients anaesthetized with nitrous oxide halothane and fentanyl
    Canadian Journal of Anaesthesia-journal Canadien D Anesthesie, 1991
    Co-Authors: J M K H Wierda, L M Lambalk, U W Kleef, Wybe D Kloppenburg, S Agoston
    Abstract:

    The pharmacodynamics and pharmacokinetics of a new non-depolarizing Neuromuscular Blocking Agent, Org 9426, were investigated. Ten patients undergoing elective head and neck surgery and anaesthetized with nitrous oxide, halothane and fentanyl, received a bolus dose of Org 9426 (1 mg.kg-1, 3 x ED90). The isometric contractions of the adductor pollicis muscle following ulnar nerve stimulation (0.1 Hz and intermittent TOF) were measured. Blood and urine were sampled over 8 and 24 hr, respectively. Concentrations of Org 9426 and its possible metabolites in plasma and urine were determined using HPLC. Pharmacokinetic variables were calculated by iterative linear least square regression analysis. Intubation conditions were excellent one minute after administration at a Neuromuscular block of 88 (13)% (Mean (CV]. Onset time until maximum block, duration until 25% recovery of twitch height, and recovery from 25 until 75% of twitch height were 1.7 (32), 53 (19) and 20 (37) min, respectively. The TOF reached a ratio of 0.7 after 87 (19) min. Half lives were 1.8 (33), 19 (34), 131 (62) min, respectively, in a three exponential decay; distribution volume at steady-state and plasma clearance were 0.264 (56) L.kg-1 and 4.0 (21) ml.kg-1.min-1, respectively. Plasma concentration at 25% recovery of the twitch height was 1.0 mg.L-1. Within 24 h, 33 (37)% of Org 9426 was excreted unchanged in the urine. Metabolites were absent both in plasma and urine. We conclude that the difference in potency between Org 9426 and vecuronium is similar to the difference between their effective concentrations.(ABSTRACT TRUNCATED AT 250 WORDS)