BACKGROUND Donepezil is an acetylcholinesterase inhibitor used to improve cognition and delay disease progression in dementia patients by increasing acetylcholine levels.This drug may potentially interact with neuromu...BACKGROUND Donepezil is an acetylcholinesterase inhibitor used to improve cognition and delay disease progression in dementia patients by increasing acetylcholine levels.This drug may potentially interact with neuromuscular blocking agents(NMBAs)that act on muscular acetylcholine receptors during general anesthesia.Herein,we present a case of inadequate neuromuscular blockade with rocuronium,a nondepolarizing NMBA,in a dementia patient who had taken donepezil.CASE SUMMARY A 71-year-old man was scheduled for laparoscopic gastrectomy.He had been taking donepezil 5 mg for dementia.General anesthesia was induced with propofol and remifentanil.The depth of neuromuscular blockade was monitored by train-of-four(TOF)stimulation.After the administration of rocuronium,the TOF ratio decreased at an unusually slow rate,and a TOF count of 0 was detected 7 min later.After intubation,a TOF count of 1 was detected within 1 min,and a TOF ratio of 12%was detected within 2 min.The TOF count remained at 4 even with an additional bolus and continuous infusion of rocuronium,suggesting resistance to this NMBA.Instead of propofol,an inhalation anesthetic was administered alongside another NMBA(cisatracurium).Then,the quality of neuromuscular blockade improved,and the TOF count remained at 0-1 for the next 70 min.No further problems were encountered with respect to surgery or anesthesia.CONCLUSION Donepezil may be responsible for inadequate neuromuscular blockade during anesthesia,especially when total intravenous anesthesia is used.展开更多
Neuromuscular blocking agents(NMBAs)are extensively used during anesthesia to improve surgical conditions by relaxing skeletal muscle movements.Rapid neuromuscular recovery after surgery is desirable to facilitate the...Neuromuscular blocking agents(NMBAs)are extensively used during anesthesia to improve surgical conditions by relaxing skeletal muscle movements.Rapid neuromuscular recovery after surgery is desirable to facilitate the recovery of muscle function and prevent residual blockade.Decamethonium(C10)is a classic NMBA,which has been restricted over the past decades ascribed to lack of a suitable antidote in clinic.Herein we used carboxylatopillar[6]arene(CP6A)to reverse neuromuscular blocker effect of C10 through direct host-guest encapsulation.NMR and isothermal titration calorimetry served to confirm the complexation between CP6A and C10 with robust affinity[(1.07±0.14)×10^(7)L/mol].The CP6A was further used as a reversal agent of C10,which facilitated to decrease C10 concentration in mice blood and excrete via urinary clearance,resulting in rapid recovery from muscle relaxation.These favorable outcomes might lead us to suggest that this supramolecular strategy could allow patients to regain lucidity much faster than spontaneous recovery from anesthesia.展开更多
2023年6月16日,欧洲危重症医学会(the European Society of Intensive Care Medicine,ESICM)在《重症监护医学杂志(Intensive Care Medicine,ICM)》发布了《ESICM急性呼吸窘迫综合征指南:定义、表型和呼吸支持策略》(以下简称2023版指南...2023年6月16日,欧洲危重症医学会(the European Society of Intensive Care Medicine,ESICM)在《重症监护医学杂志(Intensive Care Medicine,ICM)》发布了《ESICM急性呼吸窘迫综合征指南:定义、表型和呼吸支持策略》(以下简称2023版指南)。与2017版指南相比,2023版指南增加了“定义”和“表型”两个领域,但只是进行了阐述,并未给出推荐意见;针对“呼吸支持策略”,2023版指南增加了“经鼻高流量氧疗(high flow nasal cannula oxygen,HFNO)”“无创通气(noninvasive ventilation,NIV)”“神经肌肉阻滞剂”和“体外二氧化碳清除(extracorporeal carbon dioxide removal,ECCO_(2)R)”四个模块,对呼吸支持策略给出了相应的推荐意见;同时还针对2019年新型冠状病毒感染(COVID-19)患者给出了额外的推荐意见。但2023版指南并未明确给出ARDS新定义,2023年7月24日《美国呼吸与危重病医学杂志(American Journal of Respiratory and Critical Care Medicine,AJRCCM)》给出了ARDS的全球新定义,填补了2023版指南的定义部分。本文结合2023版指南及ARDS全球新定义对指南进行了解读,以供重症同仁参考。展开更多
文摘BACKGROUND Donepezil is an acetylcholinesterase inhibitor used to improve cognition and delay disease progression in dementia patients by increasing acetylcholine levels.This drug may potentially interact with neuromuscular blocking agents(NMBAs)that act on muscular acetylcholine receptors during general anesthesia.Herein,we present a case of inadequate neuromuscular blockade with rocuronium,a nondepolarizing NMBA,in a dementia patient who had taken donepezil.CASE SUMMARY A 71-year-old man was scheduled for laparoscopic gastrectomy.He had been taking donepezil 5 mg for dementia.General anesthesia was induced with propofol and remifentanil.The depth of neuromuscular blockade was monitored by train-of-four(TOF)stimulation.After the administration of rocuronium,the TOF ratio decreased at an unusually slow rate,and a TOF count of 0 was detected 7 min later.After intubation,a TOF count of 1 was detected within 1 min,and a TOF ratio of 12%was detected within 2 min.The TOF count remained at 4 even with an additional bolus and continuous infusion of rocuronium,suggesting resistance to this NMBA.Instead of propofol,an inhalation anesthetic was administered alongside another NMBA(cisatracurium).Then,the quality of neuromuscular blockade improved,and the TOF count remained at 0-1 for the next 70 min.No further problems were encountered with respect to surgery or anesthesia.CONCLUSION Donepezil may be responsible for inadequate neuromuscular blockade during anesthesia,especially when total intravenous anesthesia is used.
基金the Natural Science Foundation of Beijing Municipality(No.7204285)the National Natural Science Foundation of China(Nos.81573354,21772118,21971192)。
文摘Neuromuscular blocking agents(NMBAs)are extensively used during anesthesia to improve surgical conditions by relaxing skeletal muscle movements.Rapid neuromuscular recovery after surgery is desirable to facilitate the recovery of muscle function and prevent residual blockade.Decamethonium(C10)is a classic NMBA,which has been restricted over the past decades ascribed to lack of a suitable antidote in clinic.Herein we used carboxylatopillar[6]arene(CP6A)to reverse neuromuscular blocker effect of C10 through direct host-guest encapsulation.NMR and isothermal titration calorimetry served to confirm the complexation between CP6A and C10 with robust affinity[(1.07±0.14)×10^(7)L/mol].The CP6A was further used as a reversal agent of C10,which facilitated to decrease C10 concentration in mice blood and excrete via urinary clearance,resulting in rapid recovery from muscle relaxation.These favorable outcomes might lead us to suggest that this supramolecular strategy could allow patients to regain lucidity much faster than spontaneous recovery from anesthesia.
文摘2023年6月16日,欧洲危重症医学会(the European Society of Intensive Care Medicine,ESICM)在《重症监护医学杂志(Intensive Care Medicine,ICM)》发布了《ESICM急性呼吸窘迫综合征指南:定义、表型和呼吸支持策略》(以下简称2023版指南)。与2017版指南相比,2023版指南增加了“定义”和“表型”两个领域,但只是进行了阐述,并未给出推荐意见;针对“呼吸支持策略”,2023版指南增加了“经鼻高流量氧疗(high flow nasal cannula oxygen,HFNO)”“无创通气(noninvasive ventilation,NIV)”“神经肌肉阻滞剂”和“体外二氧化碳清除(extracorporeal carbon dioxide removal,ECCO_(2)R)”四个模块,对呼吸支持策略给出了相应的推荐意见;同时还针对2019年新型冠状病毒感染(COVID-19)患者给出了额外的推荐意见。但2023版指南并未明确给出ARDS新定义,2023年7月24日《美国呼吸与危重病医学杂志(American Journal of Respiratory and Critical Care Medicine,AJRCCM)》给出了ARDS的全球新定义,填补了2023版指南的定义部分。本文结合2023版指南及ARDS全球新定义对指南进行了解读,以供重症同仁参考。
