Asunto(s)
Analgésicos Opioides/envenenamiento , Anestésicos/envenenamiento , Homicidio , Relajantes Musculares Centrales/envenenamiento , Adulto , Androstanoles/envenenamiento , Femenino , Fentanilo/envenenamiento , Humanos , Masculino , Midazolam/envenenamiento , Persona de Mediana Edad , Fármacos Neuromusculares Despolarizantes/envenenamiento , Fármacos Neuromusculares no Despolarizantes/envenenamiento , Pancuronio/envenenamiento , Rocuronio , Succinilcolina/envenenamiento , Adulto JovenAsunto(s)
Anestesiología/métodos , Bloqueo Neuromuscular/métodos , Bloqueantes Neuromusculares/uso terapéutico , Anestesiología/tendencias , Inhibidores de la Colinesterasa/uso terapéutico , Cuidados Críticos/métodos , Cuidados Críticos/tendencias , Humanos , Bloqueo Neuromuscular/efectos adversos , Bloqueo Neuromuscular/tendencias , Bloqueantes Neuromusculares/efectos adversos , Bloqueantes Neuromusculares/antagonistas & inhibidores , Unión Neuromuscular/efectos de los fármacos , Fármacos Neuromusculares no Despolarizantes/uso terapéutico , Filosofía Médica , Seguridad , Succinilcolina/uso terapéutico , Sugammadex , Pensamiento , gamma-Ciclodextrinas/uso terapéuticoRESUMEN
Although antiquated and long targeted for obsolescence, neostigmine and succinylcholine still serve the anesthesia community, decades after their inferior pharmacological profiles have been recognized. The need to quickly establish a good intubation condition with a relaxant that will recover rapidly is fundamental to safe anesthesia practice. So is the need to restore muscle power safely and quickly at the end of surgery, by reversing a residual neuromuscular block. Recent data have shown that sugammadex can safely and rapidly reverse profound neuromuscular block established by rocuronium and vecuronium. This allows for use of rocuronium to establish a good intubation condition, and use of sugammadex to terminate the neuromuscular block at will. The present article assesses the clinical implications of such therapeutic regimen, and provides an educated guess on how the clinical neuromuscular practice might change, if and when sugammadex becomes clinically available.
Asunto(s)
Inhibidores de la Colinesterasa/efectos adversos , Neostigmina/efectos adversos , Fármacos Neuromusculares no Despolarizantes/antagonistas & inhibidores , Succinilcolina/efectos adversos , gamma-Ciclodextrinas/uso terapéutico , Androstanoles/antagonistas & inhibidores , Periodo de Recuperación de la Anestesia , Química Farmacéutica , Relación Dosis-Respuesta a Droga , Diseño de Fármacos , Monitoreo de Drogas , Utilización de Medicamentos , Edrofonio/efectos adversos , Predicción , Humanos , Monitoreo Intraoperatorio , Bloqueo Neuromuscular/efectos adversos , Bloqueo Neuromuscular/métodos , Bloqueo Neuromuscular/tendencias , Selección de Paciente , Bromuro de Piridostigmina/efectos adversos , Rocuronio , Seguridad , Sugammadex , Bromuro de Vecuronio/antagonistas & inhibidoresRESUMEN
PURPOSE: Sialoendoscopy is a novel minimally invasive technique to explore the salivary duct system and to treat obstructive salivary disease. This article describes the early clinical experience with endoscopic salivary duct exploration and sialolithectomy in 2 medical centers. PATIENTS AND METHODS: This is a retrospective case series of 94 patients, with submandibular (n = 77) or parotid (n = 17) sialadenitis secondary to sialolithiasis, strictures, or mucous plugs. Patients underwent sialoendoscopy at Baptist Hospital, Miami (n = 52) or at Massachusetts General Hospital, Boston (n = 42). Dilatation of the duct through the natural orifice was accomplished with salivary dilators. Three endoscope systems with diameters from 1.1 to 2.3 mm were used. Using a basket, grasper, lithotripsy, laser, or a combination of these, stones were fragmented or removed endoscopically. Strictures were dilated and mucous plugs removed. All cases were carried out under general anesthesia. RESULTS: Salivary duct navigation was accomplished in 91/94 patients. In 3 cases, duct dilatation was not possible due to scarring. Symptomatic relief was achieved in 81/91 patients (89.4%). Strictures and mucous plugs were visualized and managed in 18/18 patients. Sialoliths were visualized in 73 patients and stone fragmentation or retrieval was accomplished in 84.93% (62/73) of cases. Complications included 2 patients with temporary lingual nerve paresthesia and 1 patient with excess extravasation of irrigation fluid. CONCLUSION: The results of this study indicate that interventional sialoendoscopy is an effective, minimally invasive alternative treatment for obstructive salivary gland disease.