All the questions you wanted to ask about muscle relaxants but didn't echo report of the 7th International Neuromuscular Meeting

This paper presents an echo of what transpired during the meeting written in a question ans answer format.

Diabetic polyneuropathy: mechanisms, prevention and treatment, are we doing too little, too late?

Diabetic polyneuropathy affects millions of people with diabetes. Although, the symptoms may be highly unpleasant, management have concentrated mainly on the disease process and other more visible or devastating secondary complications like diabetic ulcers and cardiac arrhythmia. Glycemic control remains the most important aspect in the management of diabetes that can deter or decelerate subsequent development of diabetic polyneuropathy. However, concentration on this aspect alone veers away from control of symptoms that may improve quality of life of patients.

A comparative study of epidural bupivacaine and epidural bupivacaine with clonidine in providing intraoperative and postoperative analgesia in Filipino gynecologic patients: A randomized, double-blind, clinical trial

BACKGROUND: Clonidine, an alpha-agonist has been postulated to produce analgesia centrally by stimulating the post-synaptic activity of norepinephrine through receptors distinct from opioid receptors and peripherally through a mechanism similar to local anesthetics. It has been suggested that the use of a combination of local anesthetics and clonidine both at lower doses may be effective in providing adequate analgesia at the same time minimizing the deleterious side effects of each drug when used alone at higher doses. The objective of the study was the determination of the minimum dosage of clonidine in combination with bupivacaine necessary for epidural administration that would provide optimal intraoperative and postoperative analgesia with the least occurrence of side effects such as hypotension and bradycardia. METHODOLOGY: One hundred randomly selected, healthy ASA l and 2 gynecologic patients undergoing lower abdominal surgery under epidural anesthesia were given bupivacaine 0.5 percent epidurally compounded with either saline as placebo (Group 1), or clonidine in variable doses: 0.5 ug/kg (Group 2), 1.0 ug/kg (Group 3), and 1.5 ug/kg (Group 4) in a randomized, double-blind fashion. The vital signs were noted every 5 minutes. Analgesia was monitored and recorded using the Visual Analog Scale (VAS), Verbal Rate Scoring and the systemic indicators of pain perception (SBP 30 min Hg increase from baseline or heart rate 20 percent from baseline). A top-up dose of Lidocaine 2 percent was given with systemic indications of pain perception noted intraoperatively or rescue doses of opioids were given when the systemic indications of pain perception were noted at the post anesthesia care unit, upon which data collection was terminated Eighty two patients completed the course of data collection while eighteen were dropped out because of sacral sparing, retraction pain and extension of incision. The statistical tool utilized to test significant differences between the groups was the Kruskal-Wallis Analysis of Variance test and the Partitioned Chi-square test. RESULTS: There is prolongation in the duration of analgesia with incremental increase in clonidine dose. Hypotension occurred even without the addition of clonidine with higher incidence as the dose of clonidine increased. The least side effects occurred with doses of clonidine between 0.5 and 1.0 ug/kg. CONCLUSION: The optimal dosage of clonidine for intraoperative analgesia that would extend to the postoperative period in Filipino women would fall between 0.5 to 1.0 ug/kg. (Author)

Adjuvants to regional anaesthesia

This discussion will focus on non-narcotic adjuvants to regional anaesthesia. Specifically, this paper will explore the use of alpha-2-adrenergic agonists (i.e. clonidine), anticholinestease (neostigmine) and a phencyclidine (ketamine) combined with local anaesthetics for regional and peripheral nerve blocks or used systematically to enhanced analgesia from local anaesthetic techniques. The spinal gaba- ergic system (i.e. midazolam) is primarily an inhibitory system. Enhancing inhibition is an exciting mechanism that is being explored at the present time, and is not discussed in this paper.