1/17. Unexpected prolonged neuromuscular block after mivacurium: a case report.OBJECTIVE: To present a case of unexpected prolonged apnoea following the administration of mivacurium, a short-acting muscle relaxant and to identify the factors for early diagnosis and management. CLINICAL PRESENTATION AND INTERVENTION: A 19-year-old physically fit lady without personal or family history suggestive of anaesthetic problems had an excision of fibro-adenoma from the breast. She did not recover as quickly as was expected from the anaesthetic, which included the administration of mivacurium. She had prolonged neuromuscular blockade. She was kept ventilated and sedated. Five hours after the last dose of mivacurium, she showed signs of spontaneous respiration and at 6 h she was extubated and fully recovered. It was shown later that the patient had a pseudocholinesterase deficiency. CONCLUSION: pseudocholinesterase deficiency is an uncommon occurrence but should be highly suspected in cases of prolonged paralysis following the administration of a short-acting muscle relaxant. The use of a nerve stimulator is recommended whenever muscle relaxants are used. Muscle relaxants should be used only when facilities for prolonged ventilation are available.- - - - - - - - - - ranking = 1keywords = respiration (Clic here for more details about this article) |
2/17. Bialaphos poisoning with apnea and metabolic acidosis.A 64-year-old man with ethanol intoxication, ingested a bottle of Herbiace (100 ml, 32 w/v% of bialaphos, CAS #35597-43-4, Meiji Seika Kaisha, tokyo, japan). He had severe metabolic acidosis and was treated with infusions of sodium bicarbonate and furosemide, plus gastric lavage and enema. The metabolic acidosis improved 15 hours after treatment but nystagmus, apnea and convulsions were progressive. Although his sensorium was clear, spontaneous respirations were not observed for 64 hours. The electroencephalographic findings of atypical triphasic waves and slow waves suggest a unique response to bialaphos poisoning. His clinical course indicates that the management of apnea is critically important to recovery from bialaphos poisoning.- - - - - - - - - - ranking = 1keywords = respiration (Clic here for more details about this article) |
3/17. apnea and seizures caused by nicotine ingestion.tobacco products are potentially hazardous to children. Small oral doses may create marked toxic effects. physicians treating children with gastrointestinal complaints, altered consciousness, and seizure with depressed respiration should seek a history of possible exposure to tobacco products, including gum used for smoking abstinence. Intoxication can be verified by a urine toxicology screen utilizing chromatography.- - - - - - - - - - ranking = 1keywords = respiration (Clic here for more details about this article) |
4/17. Electrophrenic respiration: report of six cases.The development of electrophrenic respiration has permitted freedom from mechanical ventilation for patients who have irreversible respiratory failure in association with high-cervical spinal cord or brainstem lesions. There are three basic criteria for successful diaphragm pacing: (1) the need for long-term mechanical ventilatory assistance, (2) a functionally intact phrenic nerve-diaphragm axis, and (3) chest wall stability. Inability to achieve satisfactory pacing can be due to malfunction of equipment, instability of the chest wall, or inadequate neuromuscular responsiveness. These features of diaphragm pacing are exemplified in a series of six patients. Three achieved independence from mechanical ventilatory assistance with full-time phrenic pacing. In one patient, only limited electrophrenic respiration was achieved, and in another the method was entirely unsuccessful. Although functioning well, pacing systems were removed from the sixth patient because of infection. diaphragm pacing can be a valuable form of respiratory support for carefully selected patients.- - - - - - - - - - ranking = 6keywords = respiration (Clic here for more details about this article) |
5/17. Nasal continuous positive airway pressure in the treatment of whooping cough.A 3-week-old baby, suffering from whooping cough with severe attacks of apnoea and hypoxia, was treated by nasal CPAP with a positive airway pressure of about 5 cm H2O. The respiration improved rapidly and the transcutaneous oxygen tension increased to a normal level. The treatment was carried on for 7 days and discontinued gradually in the course of 3 days. The child was also treated with pertussis immunoglobulin and erythromycin. The CPAP system employed is easily and rapidly applied and allows normal nursing of the child during the treatment and manual lung physiotherapy in upright position. The treatment probably proved lifesaving.- - - - - - - - - - ranking = 1keywords = respiration (Clic here for more details about this article) |
6/17. succinylcholine apnoea: attempted reversal with anticholinesterases.Anticholinesterases were administered in an attempt to antagonize prolonged neuromuscular blockade following the administration of succinylcholine in a patient later found to be homozygous for atypical plasma cholinesterase. edrophonium 10 mg, given 74 min after succinylcholine, when train-of-four stimulation was characteristic of phase II block, produced partial antagonism which was not sustained. Repeated doses of edrophonium to 70 mg and neostigmine to 2.5 mg did not antagonize or augment the block. Spontaneous respiration recommenced 200 min after succinylcholine administration. It is concluded that anticholinesterases are only partially effective in restoring neuromuscular function in succinylcholine apnoea despite muscle twitch activity typical of phase II block.- - - - - - - - - - ranking = 1keywords = respiration (Clic here for more details about this article) |
7/17. Ventilatory studies in two older infants with prolonged apnea.Two infants, both born before term, were found apneic, cyanotic and limp at home when they were 9 weeks and 2 weeks old, respectively. Their respiration was monitored in the hospital and found to be remarkably periodic during sleep, and was in one case accompanied by pronounced bradycardia. The periodic breathing and apnea seemed to be caused by a decreased oxygen tension which can induce an instability of the central respiratory control mechanisms.- - - - - - - - - - ranking = 1keywords = respiration (Clic here for more details about this article) |
8/17. Prolonged succinylcholine-induced apnea caused by atypical cholinesterase: report of case.A case of prolonged apnea after administration of succinylcholine in a patient homozygous for the dibucain variant cholinesterase (genotype E1aE1a) has been presented. knowledge of the patient's medical history, preoperative laboratory tests, and the length of apnea enabled the surgical team to eliminate liver disease, carcinoma, and malnutrition from the differential diagnosis. This, in addition to the patient's failure to respond to an anticholinesterase agent, led to the belief that the patient had an atypical cholinesterase response to succinylcholine and not one secondary to a decreased production of cholinesterase enzyme from an impaired liver or prolonged paralysis for the nondepolarizing agent, pancuronium. Treatment consisted of maintaining adequate pulmonary ventilation nitrous oxide sedation to diminish anxiety until the patient regained spontaneous respiration. Anticholinesterase agents were used after the patient had progressed to a phase II depolarization block. After a cholinesterase assay of the family's serum, all members having the atypical allele were instructed to obtain medical alert identification.- - - - - - - - - - ranking = 1keywords = respiration (Clic here for more details about this article) |
9/17. Periodic respiration in erect posture in shy-drager syndrome.Tilt-table polygraphic study in four patients with shy-drager syndrome demonstrated periodic apnoea in the erect posture. In one patient reduced hypercapneic ventilatory response and necropsy findings of neuronal loss and astrocytosis in the pontine tegmentum suggested dysfunctional respiratory neurones in the brainstem. One patient had cheyne-stokes respiration during the late stage of the illness.- - - - - - - - - - ranking = 5keywords = respiration (Clic here for more details about this article) |
10/17. An explanation for failure of impedance apnoea alarm systems.24-hour recordings of the ECG and respiration, the latter from an impedance technique, have shown a phenomenon which could account for hitherto unexplained failures of impedance apnoea alarm systems. Whenever apnoea is accompanied by bradycardia there is a pronounced increase in the amplitude of the cardiac impulse on the respiration carrier. This imitates the respiration signal and prevents the alarm from sounding. Conversely, apnoea unaccompanied by bradycardia does not present this problem and is detected by the alarm. If impedance alarm systems are to be used to detect apnoea they must be accompanied by a heart rate (ECG) detector.- - - - - - - - - - ranking = 3keywords = respiration (Clic here for more details about this article) |
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