The effects of acetylcholinesterase inhibitors on morbidity after general anesthesia and surgery
© 2020 Elsevier Ltd Non-depolarizing neuromuscular blocking agents are used during general anesthesia to facilitate intubation and optimize surgical conditions. When patients leave the operating room after surgery, postoperative residual neuromuscular block occurs frequently, increasing vulnerabilit...
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th-mahidol.563352020-06-02T12:35:18Z The effects of acetylcholinesterase inhibitors on morbidity after general anesthesia and surgery Denys Shaydenfish Karuna Wongtangman Matthias Eikermann Maximilian S. Schaefer Uniklinik Düsseldorf Universität Duisburg-Essen Faculty of Medicine, Siriraj Hospital, Mahidol University Harvard Medical School Neuroscience Pharmacology, Toxicology and Pharmaceutics © 2020 Elsevier Ltd Non-depolarizing neuromuscular blocking agents are used during general anesthesia to facilitate intubation and optimize surgical conditions. When patients leave the operating room after surgery, postoperative residual neuromuscular block occurs frequently, increasing vulnerability to respiratory complications such as hypoxemia and unplanned postoperative mechanical ventilation. To restore neuromuscular transmission and skeletal muscle strength, anesthesiologists typically administer peripherally acting acetylcholinesterase inhibitors such as neostigmine. However, neostigmine's desirable effects have a narrow therapeutic range. Even at recommended dose (15–50 μg/kg), neostigmine induces nicotinic (upper airway muscle weakness leading to dysphagia and upper airway obstruction, and decreased maximum inspiratory airflow) and muscarinic (blurred vision, bronchial constriction, abdominal cramping and nausea) side effects. Recent data have questioned as to whether neostigmine reversal of neuromuscular blockade improves relevant patient outcomes such as postoperative respiratory and perioperative cardiovascular complications. A central strategy to avoid side effects of neuromuscular blocking agents is their judicious use based on quantitative monitoring of neuromuscular transmission using repetitive peripheral nerve stimulation (train-of-four ratio). Peripherally acting acetylcholinesterase inhibitors such as neostigmine should then only be administered when indicated and dosed based on results of the train-of-four ratio. 2020-06-02T05:31:37Z 2020-06-02T05:31:37Z 2020-08-15 Review Neuropharmacology. Vol.173, (2020) 10.1016/j.neuropharm.2020.108134 18737064 00283908 2-s2.0-85085035936 https://repository.li.mahidol.ac.th/handle/123456789/56335 Mahidol University SCOPUS https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85085035936&origin=inward |
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Neuroscience Pharmacology, Toxicology and Pharmaceutics Denys Shaydenfish Karuna Wongtangman Matthias Eikermann Maximilian S. Schaefer The effects of acetylcholinesterase inhibitors on morbidity after general anesthesia and surgery |
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© 2020 Elsevier Ltd Non-depolarizing neuromuscular blocking agents are used during general anesthesia to facilitate intubation and optimize surgical conditions. When patients leave the operating room after surgery, postoperative residual neuromuscular block occurs frequently, increasing vulnerability to respiratory complications such as hypoxemia and unplanned postoperative mechanical ventilation. To restore neuromuscular transmission and skeletal muscle strength, anesthesiologists typically administer peripherally acting acetylcholinesterase inhibitors such as neostigmine. However, neostigmine's desirable effects have a narrow therapeutic range. Even at recommended dose (15–50 μg/kg), neostigmine induces nicotinic (upper airway muscle weakness leading to dysphagia and upper airway obstruction, and decreased maximum inspiratory airflow) and muscarinic (blurred vision, bronchial constriction, abdominal cramping and nausea) side effects. Recent data have questioned as to whether neostigmine reversal of neuromuscular blockade improves relevant patient outcomes such as postoperative respiratory and perioperative cardiovascular complications. A central strategy to avoid side effects of neuromuscular blocking agents is their judicious use based on quantitative monitoring of neuromuscular transmission using repetitive peripheral nerve stimulation (train-of-four ratio). Peripherally acting acetylcholinesterase inhibitors such as neostigmine should then only be administered when indicated and dosed based on results of the train-of-four ratio. |
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Uniklinik Düsseldorf |
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Uniklinik Düsseldorf Denys Shaydenfish Karuna Wongtangman Matthias Eikermann Maximilian S. Schaefer |
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Review |
author |
Denys Shaydenfish Karuna Wongtangman Matthias Eikermann Maximilian S. Schaefer |
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Denys Shaydenfish |
title |
The effects of acetylcholinesterase inhibitors on morbidity after general anesthesia and surgery |
title_short |
The effects of acetylcholinesterase inhibitors on morbidity after general anesthesia and surgery |
title_full |
The effects of acetylcholinesterase inhibitors on morbidity after general anesthesia and surgery |
title_fullStr |
The effects of acetylcholinesterase inhibitors on morbidity after general anesthesia and surgery |
title_full_unstemmed |
The effects of acetylcholinesterase inhibitors on morbidity after general anesthesia and surgery |
title_sort |
effects of acetylcholinesterase inhibitors on morbidity after general anesthesia and surgery |
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2020 |
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https://repository.li.mahidol.ac.th/handle/123456789/56335 |
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1763494055793131520 |