Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0392326 (discomfort)
 22,423 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Obstetric patients undergoing caesarean section under general anaesthesia require rapid induction due to high risk of aspiration. Rocuronium provides the shortest onset of action of nondepolarizing blocking agents. Onset time can be shortened by the priming principle. Ketamine has been shown to improve intubating conditions when used in association with rocuronium. Even if ketamine crosses the placenta rapidly, it does not produce neonatal depression unless used in doses above 1-1.5 mg x kg(-1). We present a case of elective caesarean section due to pelvic disproportion managed in general anaesthesia. Following 5 min of preoxygenation, a priming dose of 0.04 mg x kg(-1) of rocuronium was administered. The patient was maintained on spontaneous breathing with 100% oxygen by face mask for 3 min and then induced in rapid sequence with thiopental 2 mg x kg(-1), ketamine 1 mg x kg(-1) and 0.4 mg x kg(-1) or rocuronium. Intubation was performed 30 s after induction (twitch tension 17%) with an excellent clinical intubating score. No adverse events such as muscle weakness or patient discomfort were observed or reported by the patient. Time from injection of the intubating does of rocuronium to recovery of 25% of single twitch was 26 min. Recovery index (T25-75) was, instead, of 3 min and 25 s. The combination of the induction agents thiopental and ketamine, associated with low dose priming with rocuronium, have guaranteed excellent intubating conditions in this clinical context.
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PMID:Thiopental--ketamine association and low dose priming with rocuronium for rapid sequence in duction of anaesthesia for elective cesareum section. 1677 Mar 9

Rocuronium is a nondepolarizing neuromuscular blocking agent used in anesthesia induction and is associated with considerable discomfort and burning pain during injection, which is reported to occur in 50-80% of patients. This study was carried out to investigate the effectiveness of intravenous paracetamol pretreatment compared with lidocaine and normal saline to prevent rocuronium injection pain. The study included 150 ASA I-II patients undergoing elective orthopedic, gastrointestinal, and gynecological procedures under general anesthesia. They were allocated into three groups according to pretreatment drugs: lidocaine (40 mg) (n = 50), paracetamol (n = 50), and normal saline group (n = 50). Before anesthesia induction with propofol, all patients were pretreated with rocuronium. The pain caused by the injection was evaluated. Local signs were assessed on the arm at the end of the injection, as well as 24 hours after recovery from anesthesia. There were no patients with blurred speech or vision and there was no respiratory depression in any group after pretreatment with the study drug. The level of pain on injection was statistically lower in those who had received paracetamol compared to normal saline (p = 0.009). There were more patients in the saline group with severe pain (p < 0.001). Paracetamol relieved the rocuronium injection pain better than normal saline but lidocaine was the best of the three drugs (p < 0.001).
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PMID:The effect of intravenous paracetamol for the prevention of rocuronium injection pain. 2545 46

Neuromuscular block results in the loss of muscular tone in the upper airway, which might contribute to the increased postoperative airway morbidity followed by ProSeal laryngeal mask airway (PLMA) insertion. We compared the pharyngolaryngeal discomfort exerted by the PLMA according to the neuromuscular block. One hundred sixty patients undergoing surgery for breast disease or inguinal hernia were anesthetized with propofol and remifentanil by target controlled infusion. Rocuronium 0.6 mg/kg (NMBA group, n = 80) or normal saline (No-NMBA group, n = 80) was administered after the loss of consciousness, and one anesthesiologist inserted the PLMA. Postoperative pharyngolaryngeal discomfort was evaluated at postoperative 1 h. Traumatic event was recorded based on the blood trace on the surface of the PLMA cuff. Insertion time, insertion attempt number, sealing pressure, and fiberoptic brochoscopic grades were evaluated. Patients' characteristics and the PLMA insertion condition (insertion time, successful insertion attempt number, fiberoptic bronchoscopic grade, and sealing pressure) were similar between the two groups. The PLMA can be successfully inserted in non-paralyzed patients with less postoperative pharyngolaryngeal discomfort than when a neuromuscular blocking agent is used (13.8% vs. 30.0%, P = 0.021). The incidence of traumatic events is also reduced when no neuromuscular blocking agent is used (16.3% vs. 32.5%, P = 0.026). Regardless of whether or not a surgical procedure requires muscular relaxation, there is no need to administer neuromuscular blocking agents solely for the purpose of PLMA insertion.
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PMID:Effect of Paralysis at the Time of ProSeal Laryngeal Mask Airway Insertion on Pharyngolaryngeal Morbidities. A Randomized Trial. 2625 22