Editorial Material
Anesthesiology
Manfred Blobner, Jennifer M. Hunter, Kurt Ulm
Summary: In 2020, the STRONGER study demonstrated that sugammadex is associated with fewer postoperative pulmonary complications compared to neostigmine. The STIL-STRONGER study, a secondary analysis of the same data, further supported the advantages of sugammadex over neostigmine in high-risk and older patients undergoing prolonged, elective surgery. We discuss the implications of the detailed statistical analysis used in these studies and how its limitations may have influenced the observed differences in postoperative pulmonary complications between the two drugs.
BRITISH JOURNAL OF ANAESTHESIA
(2023)
Review
Anesthesiology
J. A. Jeevendra Martyn, Jamie L. Sparling, Edward A. Bittner
Summary: Despite frequent use, the changes in neuromuscular transmission and underlying molecular mechanisms in critical illness are not well understood. This review provides insights into the structure and function of the neuromuscular junction, its transformation in critical illness, and the consequences of neuromuscular blocking agent use in this context. It enhances understanding of therapeutic effects and novel pathways of these agents in acquired pathologic states of critical illness.
BRITISH JOURNAL OF ANAESTHESIA
(2023)
Article
Anesthesiology
Faraj K. Alenezi, Khalid Alnababtah, Mohammed M. Alqahtani, Lafi Olayan, Mohammed Alharbi
Summary: This study found that residual neuromuscular blockade (RNMB) is a significant factor contributing to the increased incidence of critical respiratory events during PACU stay among adult patients undergoing general anaesthesia, especially in female patients, those not undergoing quantitative neuromuscular monitoring, and those with shorter surgery durations. Therefore, routine quantitative neuromuscular monitoring is recommended to reduce the incidence of RNMB.
PERIOPERATIVE MEDICINE
(2021)
Article
Medicine, General & Internal
HaoTian Wu, ZengMao Lin, RuiHao Zhou, SuiSui Huang, LingJun Chen, Yang Su, LuoNa Cheng, Huan Zhang
Summary: Little is known about the recent use of neuromuscular blocking agents (NMBAs) and monitoring in China. A nationwide survey was conducted to obtain information on the current management of NMBAs in China. The results showed a low frequency of using reversal agents and monitors in China.
FRONTIERS IN MEDICINE
(2022)
Review
Medicine, Research & Experimental
Jonathan Rodriguez-Blanco, Tomas Rodriguez-Yanez, Jesus Daniel Rodriguez-Blanco, Amilkar Jose Almanza-Hurtado, Maria Cristina Martinez-Avila, Diana Borre-Naranjo, Maria Camila Acuna Caballero, Carmelo Duenas-Castell
Summary: Neuromuscular blocking agents (NMBA) are a controversial therapeutic option in critically ill patients, and their routine use is not supported by current evidence. Monitoring protocols should be established to prevent adverse effects and complications. However, further prospective studies are needed to expand the use of NMBA in critical settings.
JOURNAL OF INTERNATIONAL MEDICAL RESEARCH
(2022)
Review
Anesthesiology
Thomas Fuchs-Buder, Sorin J. Brull, Malin Jonsson Fagerlund, Ross J. Renew, Guy Cammu, Glenn S. Murphy, Michiel Warle, Matias Vested, Bela Fulesdi, Reka Nemes, Malachy O. Columb, Daniela Damian, Peter J. Davis, Haijme Iwasaki, Lars I. Eriksson
Summary: This article introduces the guidelines for good clinical research practice in pharmacodynamic studies of neuromuscular blocking agents and emphasizes the importance and need for their revision.
ACTA ANAESTHESIOLOGICA SCANDINAVICA
(2023)
Article
Immunology
Jose A. Villegas, Jerome Van Wassenhove, Judith Merrheim, Karen Matta, Samy Hamadache, Clemence Flaugere, Pauline Pothin, Frederique Truffault, Sebastien Hascoet, Nicola Santelmo, Marco Alifano, Sonia Berrih-Aknin, Rozen le Panse, Nadine Dragin
Summary: Acetylcholine receptor (AChR) myasthenia gravis (MG) is a chronic autoimmune disease characterized by muscle weakness. The inflammatory IL-23/Th17 pathway in the thymus, blood and muscle plays a role in the disease's progression. This study investigated the potential therapeutic effects of targeting IL-23 in two preclinical MG models and found that it improved clinical symptoms and reduced inflammation and antibody production.
JOURNAL OF NEUROINFLAMMATION
(2023)
Article
Clinical Neurology
Roland Faigle, Bridget J. Chen, Rachel Krieger, Elisabeth B. Marsh, Ayham Alkhachroum, Wei Xiong, Victor C. Urrutia, Rebecca F. Gottesman
Summary: This study developed an INTRINSIC score to identify patients with ICH at low risk for critical care interventions, based on factors such as SBP, GCS, ICH volume, and IVH. The score demonstrated high sensitivity and specificity in predicting absence of critical care needs in patients with ICH.
Article
Clinical Neurology
Roland Faigle, Bridget J. Chen, Rachel Krieger, Elisabeth B. Marsh, Ayham Alkhachroum, Wei Xiong, Victor C. Urrutia, Rebecca F. Gottesman
Summary: The INTRINSIC score was developed to identify patients with intracerebral hemorrhage (ICH) at low risk for critical care interventions. It includes factors such as systolic blood pressure, Glasgow Coma Scale score, intraventricular hemorrhage, and ICH volume as predictors. The score showed good predictive ability in both the validation cohort and external validation dataset, with high sensitivity and specificity for predicting the absence of critical care needs.
Article
Anesthesiology
Harold E. Chaves-Cardona, J. Ross Renew
Summary: The purpose of this review is to identify common complications associated with the use of neuromuscular blocking agents in critically ill patients. Recent findings have shown that neuromuscular blocking agents are commonly used in the operating room to facilitate intubation and improve surgical outcomes. Similarly, in the intensive care unit, these agents are frequently used in critically ill patients who require advanced ventilatory and respiratory support. Common complications seen with the use of neuromuscular blocking agents in the intensive care unit include intensive care unit-acquired weakness, hypoxia, and respiratory adverse events associated with residual neuromuscular blockade.
CURRENT ANESTHESIOLOGY REPORTS
(2023)
Review
Neurosciences
Asher Ornoy, Gideon Koren
Summary: ADHD is a neurobehavioral condition affecting 5-10% of school-age children and 2-5% of adults. Stimulant medications like methylphenidate and amphetamines may have potential risks in pregnancy, while bupropion as an antidepressant seems to be safer. Limited data is available on the effects of ADHD medications on pregnancy and long-term neurodevelopment in children.
CURRENT NEUROPHARMACOLOGY
(2021)
Review
Critical Care Medicine
Rami Algahtani, Amedeo Merenda
Summary: With the increasing prevalence of chronic diseases, managing multimorbid patients in neuro-ICUs presents unique challenges and risks. Perioperative optimization is crucial in preventing postoperative complications, requiring thorough risk assessment and personalized management strategies for high-risk neurosurgical patients.
NEUROCRITICAL CARE
(2021)
Article
Chemistry, Multidisciplinary
Mauro Costa Morais Tavares Junior, Raphael Martus Marcon, Alexandre Fogaca Cristante, Olavo Biraghi Letaif
Summary: The use of preoperative spinal X-ray examination with traction or bending films to assess the flexibility of scoliotic curves is a reasonable option and can inform patients with neuromuscular scoliosis about the increased risks of late mechanical complications.
APPLIED SCIENCES-BASEL
(2022)
Article
Medicine, General & Internal
Sung-Hyey Byun, Jae-Min Jeon
Summary: The use of low-dose NMBA for IONM induction may lead to sinus pause or severe bradycardia caused by laryngocardiac reflex. Anesthesiologists should be aware of these risks and maintain adequate anesthesia depth.
Article
Orthopedics
Azeem Tariq Malik, Janice M. Bonsu, Megan Roser, Safdar N. Khan, Laura S. Phieffer, Thuan V. Ly, Ryan K. Harrison, Carmen E. Quatman
Summary: The study found that patients undergoing surgery for hip fractures at CAHs were less likely to experience serious complications, readmissions, and mortality compared to those at non-CAHs. Furthermore, CAHs had lower Medicare payments for hip fracture surgery patients than non-CAHs.
CLINICAL ORTHOPAEDICS AND RELATED RESEARCH
(2021)
