Severe uvular edema and resulting hypoxemia due to single use of Ecballium elaterium extract.

BACKGROUND: Ecballium elaterium (also known as squirting cucumber in the Mediterranean countries) is a weedy plant that belongs to the Cucurbitacea family. The roots and juice of its fruits were used traditionally against a wide range of diseases and symptoms, since it was known for its anti-inflammatory and analgesic effects. The use of the extract, though, has been linked to allergic reactions and toxic effects. In this report, we present a case of severe uvular edema and hypoxemia due to a single use of Ecballium elaterium extract, and we discuss the possibility of life-threatening conditions resulting from the utilization of this particular plant as a remedy. CASE REPORT: A male Caucasian presented to the ER with complaints of troubled breathing and retrosternal discomfort that started a few hours before arriving at the ER. The patient's medical history revealed the use of Ecballium elaterium extract. Clinical examination confirmed severe uvular edema and hypoxemia. Administration of oxygen and IV drugs (Hydrocortisone) relieved the symptoms and improved the patient's condition. After a 24-hour hospitalization the patient was discharged without further complaints. CONCLUSIONS: The use of Ecballium elaterium extract as a remedy can cause severe adverse effects that should not be ignored. Uvular edema is one of the most common and can lead, as shown above, to hypoxemia, which is a potentially life-threatening condition.

Sugammadex, a promising reversal drug. A review of clinical trials.

According to published data, sugammadex, rapidly reverses (2-5 min) shallow and profound NM block induced by rocuronium and vecuronium, without being connected with serious adverse events. It is accepted that in order to reverse shallow block, the suggested dose of sugammadex comes up to 2 mg/kg. Profound level of NM block demands 4 mg/kg in order to defy few responses at the post titanic count. Doses of sugammadex lower than 1 mg/kg may lead to rebound of rocuronium's effect. Higher doses of sugammadex (12 16 mg/g) are used in rescue reversal. In children and adolescents the 2 mg/kg dose is both effective and well tolerated, while, to date, data regarding infants are scarce. In patients with renal failure, 2 mg/kg of sugammadex resulted in a mean time to recovery of TOF ratio to 0.9 in 2 min, which was quicker than the time of reversal by acetylcholinesterase inhibitors. Investigations in cardiac patients undergoing noncardiac surgery suggest that 2 and 4 mg/kg of sugammadex are both safe and effective. Compared with neostigmine, sugammadex has no need to use muscarinic antagonists and therefore is not associated with variations in heart rate. Trials indicate that sugammadex acts faster than edrophonium and neostigmine. Sugammadex is a promising, well tolerated agent that enables fast reversal in different depths of NM block -shallow and profound- and in different patients populations. After completion of trial probation and settlement of issues concerning estimated cost and cost impact, it is believed to play a leading part in future anesthesiology.