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Michael H Wall - One of the best experts on this subject based on the ideXlab platform.
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Rocuronium induced coronary vasospasm kounis syndrome
International Journal of Cardiology, 2009Co-Authors: Richard E Fagley, Anna Woodbury, Alejo Visuara, Michael H WallAbstract:A 49-year-old male became hypotensive, bradycardic, and suffered myocardial injury during induction of anesthesia with lidocaine, propofol, and Rocuronium in the operating room. Coronary arteriography revealed coronary vasospasm in coronary arteries otherwise free of disease. In the ICU, the patient was again administered Rocuronium for a procedure with subsequent hypotension, bradycardia, and ST elevation on telemetry that resolved with administration of diphenhydramine and hydrocortisone. An allergic reaction to Rocuronium with coronary vasospasm is suspected, suggestive of the Type 1 variant of Kounis syndrome. This is the first report to describe a case of Rocuronium-induced Type 1 Kounis syndrome.
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Rocuronium-induced coronary vasospasm — “Kounis syndrome”
International Journal of Cardiology, 2008Co-Authors: Richard E Fagley, Anna Woodbury, Alejo Visuara, Michael H WallAbstract:Abstract A 49-year-old male became hypotensive, bradycardic, and suffered myocardial injury during induction of anesthesia with lidocaine, propofol, and Rocuronium in the operating room. Coronary arteriography revealed coronary vasospasm in coronary arteries otherwise free of disease. In the ICU, the patient was again administered Rocuronium for a procedure with subsequent hypotension, bradycardia, and ST elevation on telemetry that resolved with administration of diphenhydramine and hydrocortisone. An allergic reaction to Rocuronium with coronary vasospasm is suspected, suggestive of the Type 1 variant of Kounis syndrome. This is the first report to describe a case of Rocuronium-induced Type 1 Kounis syndrome.
Richard E Fagley - One of the best experts on this subject based on the ideXlab platform.
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Rocuronium induced coronary vasospasm kounis syndrome
International Journal of Cardiology, 2009Co-Authors: Richard E Fagley, Anna Woodbury, Alejo Visuara, Michael H WallAbstract:A 49-year-old male became hypotensive, bradycardic, and suffered myocardial injury during induction of anesthesia with lidocaine, propofol, and Rocuronium in the operating room. Coronary arteriography revealed coronary vasospasm in coronary arteries otherwise free of disease. In the ICU, the patient was again administered Rocuronium for a procedure with subsequent hypotension, bradycardia, and ST elevation on telemetry that resolved with administration of diphenhydramine and hydrocortisone. An allergic reaction to Rocuronium with coronary vasospasm is suspected, suggestive of the Type 1 variant of Kounis syndrome. This is the first report to describe a case of Rocuronium-induced Type 1 Kounis syndrome.
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Rocuronium-induced coronary vasospasm — “Kounis syndrome”
International Journal of Cardiology, 2008Co-Authors: Richard E Fagley, Anna Woodbury, Alejo Visuara, Michael H WallAbstract:Abstract A 49-year-old male became hypotensive, bradycardic, and suffered myocardial injury during induction of anesthesia with lidocaine, propofol, and Rocuronium in the operating room. Coronary arteriography revealed coronary vasospasm in coronary arteries otherwise free of disease. In the ICU, the patient was again administered Rocuronium for a procedure with subsequent hypotension, bradycardia, and ST elevation on telemetry that resolved with administration of diphenhydramine and hydrocortisone. An allergic reaction to Rocuronium with coronary vasospasm is suspected, suggestive of the Type 1 variant of Kounis syndrome. This is the first report to describe a case of Rocuronium-induced Type 1 Kounis syndrome.
Marten Heeringa - One of the best experts on this subject based on the ideXlab platform.
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a randomized dose response study of sugammadex given for the reversal of deep Rocuronium or vecuronium induced neuromuscular blockade under sevoflurane anesthesia
Anesthesia & Analgesia, 2010Co-Authors: P. Duvaldestin, Vera Saldien, Karel Kuizenga, Casper Claudius, F Servin, J Klein, B Debaene, Marten HeeringaAbstract:BACKGROUND: Sugammadex is the first of a new class of selective muscle relaxant binding drugs developed for the rapid and complete reversal of neuromuscular blockade induced by Rocuronium and vecuronium. Many studies have demonstrated a close-response relationship with sugammadex for reversal of neuromuscular blockade in patients induced and maintained under propofol anesthesia. However, sevoflurane anesthesia, unlike propofol, can prolong the effect of neuromuscular blocking drugs (NMBDs) such as Rocuronium and vecuronium. METHODS: We designed this randomized, open-label, dose-response trial to explore the dose-response relationship of sugammadex for the reversal of deep neuromuscular blockade induced by Rocuronium or vecuronium under propofol-induced and sevoflurane-maintained anesthesia. As a secondary objective, the safety variables of sugammadex were evaluated. After anesthesia induction with propofol, 102 patients aged >= 20 and RESULTS: The per-protocol population consisted of 48 patients in the Rocuronium group and 47 in the vecuronium group. A dose-response effect was demonstrated for decreased mean time to recovery of the T-4/T-1 ratio to 0.9 with increasing sugammadex dose in both NMBD groups (per-protocol Population): Rocuronium group, 79.8 (SD 33.0) min (sugammadex 0.5 mg/kg) to 1.7 (07) min (4.0 mg/kg) and 1.1 (0.3) min (8.0 mg/kg subgroup); vecuronium group, 68.4 (31.9) min (0.5 mg/kg) to 3.3 (3.5) min (4.0 mg/kg), and 1.7 (0.8) min (8.0 mg/kg subgroup). Neuromuscular monitoring showed recurrent neuromuscular blockade in 5 patients, all in the Rocuronium group (2 given sugammadex 0.5 mg/kg and 3 given 1.0 mg/kg), but there were no clinical events attributable to recurrent or residual neuromuscular blockade. CONCLUSION: Sugammadex at doses of 4 mg/kg provides rapid reversal of deep Rocuronium- and vecuronium-induced neuromuscular blockade under sevoflurane maintenance anesthesia. (Anesth Analg 2010;110:74-82)
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reversal of neuromuscular blockade by sugammadex after continuous infusion of Rocuronium in patients randomized to sevoflurane or propofol maintenance anesthesia
Anesthesiology, 2009Co-Authors: S Wagner, Henk Rietbergen, Claudia Spies, Jens Scholz, Marten Heeringa, H WulfAbstract:Background: Sugammadex rapidly reverses neuromuscular blockade induced by bolus Rocuronium doses, but it has not been investigated after continuous Rocuronium infusion in surgical patients. We therefore examined the clinical effect of sugammadex for neuromuscular blockade induced by continuous Rocuronium infusion in adults undergoing surgery under maintenance anesthesia with sevoflurane or propofol. Methods: This four-center, comparative, parallel-group study, randomly assigned 52 adult patients (American Society of Anesthesiologists Class I-III) to maintenance anesthesia with sevoflurane or propofol. Neuromuscular blockade was induced by bolus injection of 0.6 mg/kg Rocuronium followed by continuous infusion of 7 μg · kg ―1 · min ―1 Rocuronium adjusted to maintain a neuromuscular blockade depth of zero response to train-of-four and a posttetanic count of no more than 10 responses. A single dose of 4 mg/kg sugammadex was administered at first twitch (T 1 ) 3―10%. The primary clinical effect variable was recovery time to a train-of-four ratio of 0.9. Results: Median recovery time from start of sugammadex administration to a train-of-four ratio of 0.9 in the sevoflurane and propofol groups was 1.3 and 1.2 min, respectively. The estimated difference in recovery time between groups was 9 s (95% confidence interval ―6 to 20 s), entirely within the predefined equivalence interval. Median plasma Rocuronium concentration just before sugammadex administration was 33% lower during maintenance anesthesia with sevoflurane than with propofol. Sugammadex was well tolerated. One adverse event (procedural hypotension) was considered to be probably related to sugammadex. Conclusions: Single-dose sugammadex (4 mg/kg) after continuous Rocuronium infusion is equally effective and well tolerated during maintenance anesthesia with sevoflurane or propofol.
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effective reversal of moderate Rocuronium or vecuronium induced neuromuscular block with sugammadex a selective relaxant binding agent
Anesthesiology, 2007Co-Authors: Karl Morias, G Cammu, Marten Heeringa, Pol Hans, Wilbert G F Van Duijnhoven, I DemeyerAbstract:Background:Sugammadex rapidly reverses Rocuronium-induced neuromuscular block. This study explored the dose–response relation of sugammadex given as a reversal agent at reappearance of the second muscle twitch after Rocuronium- and vecuronium-induced block. A secondary objective was to investigate t
Mark J K H Wierda - One of the best experts on this subject based on the ideXlab platform.
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early reversal of profound Rocuronium induced neuromuscular blockade by sugammadex in a randomized multicenter study efficacy safety and pharmacokinetics
Anesthesiology, 2007Co-Authors: Harald J Sparr, Karel M Vermeyen, Anton M Beaufort, Henk Rietbergen, Johannes H Proost, Vera Saldien, Corinna Veliksalchner, Mark J K H WierdaAbstract:Background: Sugammadex reverses the neuromuscular blocking effects of Rocuronium by chemical encapsulation. The efficacy, safety, and pharmacokinetics of sugammadex for reversal of profound Rocuronium-induced neuromuscular blockade were evaluated. Methods: Ninety-eight male adult patients were randomly assigned to receive sugammadex (1, 2, 4, 6, or 8 mg/kg) or placebo at 3, 5, or 15 min after 0.6 mg/kg Rocuronium. Patients were anesthetized with propofol and fentanyl. The primary endpoint of the study was the time to achieve a recovery of train-of-four ratio to 0.9. Neuromuscular blockade was measured using acceleromyography. Concentrations of Rocuronium and sugammadex were determined in venous blood and urine samples. A population pharmacokinetic model using NONMEM (GloboMax LLC, Hanover, MD) was applied. Results: The mean time to recovery of the train-of-four ratio to 0.9 after dosing at 3, 5, and 15 min decreased from 52.1, 51.7, and 35.6 min, respectively, after administration of placebo to 1.8, 1.5, and 1.4 min, respectively, after 8 mg/kg sugammadex. Sugammadex was safe and well tolerated. However, 20.4% of patients showed signs of inadequate anesthesia after its administration. The median cumulative excretion of Rocuronium in the urine over 24 h was 26% in the placebo group and increased to 58-74% after 4-8 mg/kg sugammadex. The mean plasma clearances of sugammadex and Rocuronium were 0.084 and 0.26 l/min, respectively. Conclusions: In male subjects, sugammadex safely reversed profound neuromuscular blockade induced by 0.6 mg/kg Rocuronium in a dose-dependent manner. Sugammadex enhanced the renal excretion of Rocuronium, and its clearance is approximately one third that of Rocuronium.
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a temporary decrease in twitch response during reversal of Rocuronium induced muscle relaxation with a small dose of sugammadex
Anesthesia & Analgesia, 2007Co-Authors: Douglas J Eleveld, Johannes H Proost, Karel Kuizenga, Mark J K H WierdaAbstract:BACKGROUND: We present a case in which a temporary decrease in train-of-four (TOF) response was observed after reversal of muscle relaxation with a small dose (0.5 mg/kg) of sugammadex administered 42 min after 0.9 mg/kg of Rocuronium. At the end of the operation, the TOF ratio was 0.9, and the patient woke normally, without signs of muscle weakness. We describe this temporary decrease in muscle response during muscle relaxation reversal as muscle relaxation rebound and hypothesize that it occurs when the dose of sugammadex is sufficient for complex formation with Rocuronium in the central compartment, but insufficient for redistribution of Rocuronium from peripheral to central compartments. METHODS: To investigate our hypothesis, we developed and fit a simple pharmacokinetic– pharmacodynamic model of Rocuronium, sugammadex, and their interaction to the patient TOF response data. RESULTS: Simulations using the fitted model indicate that muscle relaxation rebound can occur for doses of sugammadex in a limited critical range. CONCLUSIONS: Sufficiently large doses of sugammadex eliminate the possibility for muscle relaxation rebound, which does not require dissociation of the sugammadex/ Rocuronium complex. (Anesth Analg 2007;104:582‐4)
Anna Woodbury - One of the best experts on this subject based on the ideXlab platform.
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Rocuronium induced coronary vasospasm kounis syndrome
International Journal of Cardiology, 2009Co-Authors: Richard E Fagley, Anna Woodbury, Alejo Visuara, Michael H WallAbstract:A 49-year-old male became hypotensive, bradycardic, and suffered myocardial injury during induction of anesthesia with lidocaine, propofol, and Rocuronium in the operating room. Coronary arteriography revealed coronary vasospasm in coronary arteries otherwise free of disease. In the ICU, the patient was again administered Rocuronium for a procedure with subsequent hypotension, bradycardia, and ST elevation on telemetry that resolved with administration of diphenhydramine and hydrocortisone. An allergic reaction to Rocuronium with coronary vasospasm is suspected, suggestive of the Type 1 variant of Kounis syndrome. This is the first report to describe a case of Rocuronium-induced Type 1 Kounis syndrome.
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Rocuronium-induced coronary vasospasm — “Kounis syndrome”
International Journal of Cardiology, 2008Co-Authors: Richard E Fagley, Anna Woodbury, Alejo Visuara, Michael H WallAbstract:Abstract A 49-year-old male became hypotensive, bradycardic, and suffered myocardial injury during induction of anesthesia with lidocaine, propofol, and Rocuronium in the operating room. Coronary arteriography revealed coronary vasospasm in coronary arteries otherwise free of disease. In the ICU, the patient was again administered Rocuronium for a procedure with subsequent hypotension, bradycardia, and ST elevation on telemetry that resolved with administration of diphenhydramine and hydrocortisone. An allergic reaction to Rocuronium with coronary vasospasm is suspected, suggestive of the Type 1 variant of Kounis syndrome. This is the first report to describe a case of Rocuronium-induced Type 1 Kounis syndrome.
