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
目的观察帕金森病(Parkinson's disease,PD)与非PD患者罗库溴铵的神经肌肉阻滞效应。方法纳入年龄18~65岁,美国麻醉医师协会(American Society of Anesthesiologists,ASA)Ⅰ~Ⅲ,接受丘脑底核-脑深部电刺激手术的PD患者(PD组)31例和...目的观察帕金森病(Parkinson's disease,PD)与非PD患者罗库溴铵的神经肌肉阻滞效应。方法纳入年龄18~65岁,美国麻醉医师协会(American Society of Anesthesiologists,ASA)Ⅰ~Ⅲ,接受丘脑底核-脑深部电刺激手术的PD患者(PD组)31例和行面神经减压的非PD患者(non-PD组)24例为研究对象。麻醉诱导单次给予罗库溴铵(0.6 mg/kg),采用四个成串刺激(train-of-four,TOF)监测肌松,记录罗库溴铵体内作用时间(the duration of 90%recovery of TOF,DURTOF 90%)、起效时间、临床作用时间、恢复指数和术毕2 h内严重呼吸系统并发症发生情况。结果与non-PD组比较,PD组DURTOF 90%和临床作用时间均显著延长,差异有统计学意义(P<0.05);2组患者的起效时间差异无统计学意义(P>0.05)。PD患者的罗库溴铵DURTOF 90%与病程相关,病程越长,DURTOF 90%越长。2组患者术后均无严重呼吸系统并发症发生。结论PD患者应用罗库溴铵的DURTOF 90%和临床作用时间明显延长,且DURTOF 90%与病程呈正相关。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
AIM: To evaluate the effects of two different doses of sugammadex after maintenance anesthesia with sevofluorane and remifentanil and deep rocuroniuminduced neuromuscular blockade(NMB).METHODS: Patients between 20 and...AIM: To evaluate the effects of two different doses of sugammadex after maintenance anesthesia with sevofluorane and remifentanil and deep rocuroniuminduced neuromuscular blockade(NMB).METHODS: Patients between 20 and 65 years of age, with American Society of Anesthesiologists physical status classification Ⅰ-Ⅱ, undergoing gynecological surgery were included in a prospective, comparative and randomized study. NMB was induced with an injection of 0.6 mg/kg of rocuronium followed by continuous infusion of 0.3-0.6 mg/kg per hour to maintain a deep block. Anesthesia was maintained with sevofluorane and remifentanil. Finally, when surgery was finished, a bolus of 2 mg/kg(group A) or 4 mg/kg(group B) of sugammadex was applied when the NMB first response in the train-of-four was reached. The primary clinical endpoint was time to recovery to a train-of-four ratio of 0.9. Other variables recorded were the time until recovery of train-of-four ratio of 0.7, 0.8, hemodynamic variables(arterial blood pressure and heart rate at baseline, starting sugammadex, and minutes 2, 5 and 10) and adverse events were presented after one hour in the post-anesthesia care unit.RESULTS: Thirty-two patients were included in the study: 16 patients in group A and 16 patients in group B. Only 14 patients each group were recorded because arterial pressure values were lost in two patients from each group in minute 10. The two groups were comparable. Median recovery time from starting of sugammadex administration to a train-of-four ratio of 0.9 in group A and B was 129 and 110 s, respectively.The estimated difference in recovery time between groups was 24 s(95%CI: 0 to 45 s, Hodges-Lehmann estimator), entirely within the predefined equivalence interval. Times to recovery to train-of-four ratios of 0.8(group A: 101 s; group B: 82.5 s) and 0.7(group A: 90 s; group B: 65 s) from start of sugammadex administration were not equivalent between groups. There was not a significant variation in the arterial pressure and heart rate values between the two groups and none of the patients showed any clinical evidence of residual or recurrent NMB. CONCLUSION: A dose of 2 mg/kg of sugammadex after continuous rocuronium infusion is enough to reverse the NMB when first response in the Train-OfFour is reached.展开更多
目的：探讨“沙漏法”超声引导髂筋膜间隙阻滞（fascia iliaca compartment block，FICB）用于全髋关节置换术后镇痛的有效性。方法经伦理委员会批准，选择2014年1～5月我院择期全髋关节置换术30例，腰硬联合麻醉前应用“沙漏法”行超...目的：探讨“沙漏法”超声引导髂筋膜间隙阻滞（fascia iliaca compartment block，FICB）用于全髋关节置换术后镇痛的有效性。方法经伦理委员会批准，选择2014年1～5月我院择期全髋关节置换术30例，腰硬联合麻醉前应用“沙漏法”行超声引导 FICB，辨认出“沙漏征”（腹内斜肌与缝匠肌），放置导管，给予负荷量0．2％罗哌卡因40 ml，随后连接镇痛泵，0．2％罗哌卡因10 ml ／h 持续输注，使用时间48 h。记录30 min 内股神经和股外侧皮神经感觉阻滞起效情况，阻滞后4、8、12、24、36、48 h 患者静息状态疼痛评分，阻滞后48 h 患者满意度评分，以及不良反应发生率。结果30 min 内股神经和股外侧皮神经感觉阻滞成功率100％，阻滞后4、8、12、24、36、48 h 疼痛数字评价量表（numerical rating pain scale，NRPS）中位数均＜4分，阻滞后48 h 患者满意度评分为（8．0±0．9）分。无一例出现感染、局麻药中毒、出血及血肿等并发症。结论全髋关节置换术应用“沙漏法”进行超声引导 FICB，操作安全、简便，能够为患者提供有效的术后镇痛，可在临床上推广应用。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.
文摘目的观察帕金森病(Parkinson's disease,PD)与非PD患者罗库溴铵的神经肌肉阻滞效应。方法纳入年龄18~65岁,美国麻醉医师协会(American Society of Anesthesiologists,ASA)Ⅰ~Ⅲ,接受丘脑底核-脑深部电刺激手术的PD患者(PD组)31例和行面神经减压的非PD患者(non-PD组)24例为研究对象。麻醉诱导单次给予罗库溴铵(0.6 mg/kg),采用四个成串刺激(train-of-four,TOF)监测肌松,记录罗库溴铵体内作用时间(the duration of 90%recovery of TOF,DURTOF 90%)、起效时间、临床作用时间、恢复指数和术毕2 h内严重呼吸系统并发症发生情况。结果与non-PD组比较,PD组DURTOF 90%和临床作用时间均显著延长,差异有统计学意义(P<0.05);2组患者的起效时间差异无统计学意义(P>0.05)。PD患者的罗库溴铵DURTOF 90%与病程相关,病程越长,DURTOF 90%越长。2组患者术后均无严重呼吸系统并发症发生。结论PD患者应用罗库溴铵的DURTOF 90%和临床作用时间明显延长,且DURTOF 90%与病程呈正相关。
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。
文摘AIM: To evaluate the effects of two different doses of sugammadex after maintenance anesthesia with sevofluorane and remifentanil and deep rocuroniuminduced neuromuscular blockade(NMB).METHODS: Patients between 20 and 65 years of age, with American Society of Anesthesiologists physical status classification Ⅰ-Ⅱ, undergoing gynecological surgery were included in a prospective, comparative and randomized study. NMB was induced with an injection of 0.6 mg/kg of rocuronium followed by continuous infusion of 0.3-0.6 mg/kg per hour to maintain a deep block. Anesthesia was maintained with sevofluorane and remifentanil. Finally, when surgery was finished, a bolus of 2 mg/kg(group A) or 4 mg/kg(group B) of sugammadex was applied when the NMB first response in the train-of-four was reached. The primary clinical endpoint was time to recovery to a train-of-four ratio of 0.9. Other variables recorded were the time until recovery of train-of-four ratio of 0.7, 0.8, hemodynamic variables(arterial blood pressure and heart rate at baseline, starting sugammadex, and minutes 2, 5 and 10) and adverse events were presented after one hour in the post-anesthesia care unit.RESULTS: Thirty-two patients were included in the study: 16 patients in group A and 16 patients in group B. Only 14 patients each group were recorded because arterial pressure values were lost in two patients from each group in minute 10. The two groups were comparable. Median recovery time from starting of sugammadex administration to a train-of-four ratio of 0.9 in group A and B was 129 and 110 s, respectively.The estimated difference in recovery time between groups was 24 s(95%CI: 0 to 45 s, Hodges-Lehmann estimator), entirely within the predefined equivalence interval. Times to recovery to train-of-four ratios of 0.8(group A: 101 s; group B: 82.5 s) and 0.7(group A: 90 s; group B: 65 s) from start of sugammadex administration were not equivalent between groups. There was not a significant variation in the arterial pressure and heart rate values between the two groups and none of the patients showed any clinical evidence of residual or recurrent NMB. CONCLUSION: A dose of 2 mg/kg of sugammadex after continuous rocuronium infusion is enough to reverse the NMB when first response in the Train-OfFour is reached.
文摘目的：探讨“沙漏法”超声引导髂筋膜间隙阻滞（fascia iliaca compartment block，FICB）用于全髋关节置换术后镇痛的有效性。方法经伦理委员会批准，选择2014年1～5月我院择期全髋关节置换术30例，腰硬联合麻醉前应用“沙漏法”行超声引导 FICB，辨认出“沙漏征”（腹内斜肌与缝匠肌），放置导管，给予负荷量0．2％罗哌卡因40 ml，随后连接镇痛泵，0．2％罗哌卡因10 ml ／h 持续输注，使用时间48 h。记录30 min 内股神经和股外侧皮神经感觉阻滞起效情况，阻滞后4、8、12、24、36、48 h 患者静息状态疼痛评分，阻滞后48 h 患者满意度评分，以及不良反应发生率。结果30 min 内股神经和股外侧皮神经感觉阻滞成功率100％，阻滞后4、8、12、24、36、48 h 疼痛数字评价量表（numerical rating pain scale，NRPS）中位数均＜4分，阻滞后48 h 患者满意度评分为（8．0±0．9）分。无一例出现感染、局麻药中毒、出血及血肿等并发症。结论全髋关节置换术应用“沙漏法”进行超声引导 FICB，操作安全、简便，能够为患者提供有效的术后镇痛，可在临床上推广应用。
