Subject(s)
Cholinesterase Inhibitors/economics , Costs and Cost Analysis/legislation & jurisprudence , Drug Approval/economics , Neostigmine/economics , Neuromuscular Blockade , Neuromuscular Nondepolarizing Agents/antagonists & inhibitors , Neuromuscular Nondepolarizing Agents/economics , Cholinesterase Inhibitors/administration & dosage , Humans , Marketing of Health Services , Neostigmine/administration & dosage , United States , United States Food and Drug AdministrationABSTRACT
Sugammadex sodium is a modified γ-cyclodextrin with a very high affinity for rocuronium and, to a lesser extent, vecuronium molecules. In vivo administration results in immediate encapsulation of rocuronium and vecuronium, resulting in termination of neuro- muscular blockade, usually within 3 minutes. This new neuromuscular blocking agent is specific for the aminosteroidal neuromuscular blocking agents rocuronium and vecuronium. Experience gained through worldwide clinical use of sugammadex offers US anesthesia providers the opportunity to better understand this new drug and its clinical applications. The seminal and current literature concerning clinical use of sugammadex is reviewed, and considerations for its incorporation into practice are provided.
Subject(s)
Anesthesiology/methods , Neuromuscular Blockade , Neuromuscular Nondepolarizing Agents/agonists , gamma-Cyclodextrins/administration & dosage , Androstanols/agonists , Anesthesia, Inhalation , Anesthetics, Inhalation , Dose-Response Relationship, Drug , Humans , Practice Guidelines as Topic , Sugammadex , United States , Vecuronium Bromide/antagonists & inhibitorsSubject(s)
Cholinergic Antagonists/administration & dosage , Nausea/drug therapy , Vomiting/drug therapy , Atropine/administration & dosage , Atropine/adverse effects , Cholinergic Antagonists/adverse effects , Female , Humans , Male , Nausea/prevention & control , Patient Safety , Postoperative Nausea and Vomiting/drug therapy , Postoperative Nausea and Vomiting/prevention & control , Risk Assessment , Scopolamine/administration & dosage , Scopolamine/adverse effects , Vomiting/prevention & controlSubject(s)
Colonoscopy , Mitral Valve Prolapse/physiopathology , Colonoscopy/methods , Humans , Male , Middle AgedABSTRACT
The dopamine antagonists, particularly droperidol, are effective at treating N&V. Because dopamine plays many roles in the body, especially in the brain, a degree of alteration in mental status should be expected, especially with higher doses. Other less frequent side effects include QT prolongation. When given for non chemotherapy-induced N&V treatment QT prolongation is rare. Higher doses warrant clinical awareness and ability to identify and treat prolonged QT and its sequelae. Invited authors for a following column will discuss QT prolongation and implications.
Subject(s)
Dopamine Antagonists/therapeutic use , Nausea/drug therapy , Vomiting/drug therapy , Droperidol/therapeutic use , HumansABSTRACT
The burden of orthostatic hypotension (OH) on public health is a universally recognized enigmatic clinical condition that is associated with significant increases on morbidity and mortality rates, and can take a major toll on one's quality of life. Orthostatic hypotension is predictive of vascular deaths from acute myocardial infarction, strokes in the middle aged population, and increases mortality rates when associated with diabetes, hypertension, Parkinson's disease, and patients receiving renal dialysis. The consensus definition for OH is a fall in systolic blood pressure of at least 20 mm Hg and/or diastolic blood pressure of at least 10 mm Hg within 3 minutes of quiet standing. Because neurogenic OH is often accompanied by supine hypertension, the treatment program should aim toward minimizing OH and the potential fall injuries related to cerebral hypoperfusion without exacerbating nocturnal hypertension that may lead to excessive cardiovascular complications.
