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Atracurium

Atracurium: A nondepolarizing neuromuscular blocking agent used for muscle relaxation during surgery and mechanical ventilation.
It is a bisquarternary benzylisoquinolinium compound that acts by competitively inhibiting acetylcholine at the neuromuscular junction.
Atracurium has a rapid onset and intermediate duration of action, and undergoes spontaneous degradation at physiological pH and temperature via Hofmann elimination.
Its use helps facilitate tracheal intubation and improve surgical conditions by providing muscle relaxation.

Most cited protocols related to «Atracurium»

1
Comparing Macintosh Laryngoscopy and GlideScope Videolaryngoscopy
Cited 3 times
The study protocol was approved by the Ethics Committee of Tehran University of Medical Sciences. The study was explained to all patients, and informed consent was obtained. In this randomized double blinded clinical trial, all of the patients were; ASA physical status I and II, with MET > 4, who were scheduled for elective surgery under general anesthesia in the supine position, from December 2012 till May 2013. Exclusion criteria were: age < 18 years or age > 60 years; any anatomical abnormality in the head, neck or face; any ENT, neck or thoracic surgery; smoking history; edentulous patients; estimated surgery time > 4 hours; any clinical evidence of active pulmonary disease; common cold during the recent two weeks; limited mouth opening or neck extension.
Three hundred patients were enrolled in the study. They were randomly allocated into two groups of 150 by the block randomization method: Macintosh blade laryngoscopy (ML) or Glide Scope videolaryngoscope (GVL). In the ML group; size 3 (for women) and size 4 (for men) Macintosh blades were used, and in the GVL group; size 4 reusable blades were applied in all cases. Patients and the anesthesia resident, who evaluated the patients postoperatively, were blinded. Patients were evaluated for cough and bucking at the time of extubation. After finishing the operation at 1, 6, 24 and 48 hours, the patients were visited by an anesthetist, who was blinded to the way of intubation, and they were asked about a sore throat and its severity on a three step scale (no pain, low pain and high pain) and hoarseness, (via an interview) too.
The patients were pre-oxygenated for 2 minutes with 100% O2. The patients were premedicated with; midazolam 0.03 µg/ kg, and fentanyl 3 µg/ kg. Induction of the anesthesia was performed by thiopental Na 5mg/kg, and neuromuscular paralysis was facilitated by atracurium 0.5 mg/kg. All patients were orally intubated after 3 minutes of induction by one anesthesiologist in both groups; ML or GVL groups. Intubation was performed using a low pressure cuff (Supa Inc., Tehran, Iran) with an inner diameter of 7.5 and 8 mm in women and men, respectively. No gel or lidocaine spray was used. The cuff was inflated at pressure to approximately 20-25 cmH20. Anesthesia was maintained by isoflurane 1.5-2%, and repeated doses of fentanyl and atracurium, as needed. Thirty minutes before extubation, all patients received fentanyl 50 µg intravenously.
More than three tries in the ML and GVL groups were considered to be a failure of laryngoscopy, and alternative methods (in the ML group, Glide Scope videolaryngoscope and in the GVL group, a Macintosh blade was used for intubation, and fiberoptic guided intubation was considered if required) were applied.
Age, sex, weight, ASA classification, anesthesia duration (induction till discontinuation of maintenance anesthesia), extubation time (discontinuation of maintenance anesthesia till extubation), existence of postoperative sore throat, hoarseness, and dysphagia, were measured in the patients.
A Kolmogorov-Smirnov test for goodness of fit was performed. The continuous variables were presented as mean ± SD. A Student's T test was used for comparison of means between the groups. Chi square tests were used for the categorical variables. A P value < 0.05 was considered to be significant.
Najafi A., Imani F., Makarem J., Khajavi M.R., Etezadi F., Habibi S, & Shariat Moharari R. (2014). Postoperative Sore Throat After Laryngoscopy With Macintosh or Glide Scope Video Laryngoscope Blade in Normal Airway Patients. Anesthesiology and Pain Medicine, 4(1), e15136.
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Publication 2014
Anesthesia Anesthesiologist Anesthetist Atracurium Common Cold Cough Deglutition Disorders Elective Surgical Procedures Ethics Committees Face Fentanyl General Anesthesia Head Hoarseness Intubation Isoflurane Laryngoscopy Lidocaine Lung Diseases Midazolam Neck Oral Cavity Pain Patients Physical Examination Pressure Sore Throat Thiopental Thoracic Surgical Procedures Tracheal Extubation Woman
2
Relaxing Music during Vitrectomy Surgery
Cited 2 times
This randomized clinical study was conducted on patients with American Society of Anesthesiology (ASA) classification I and II undergoing vitrectomy surgery. After approval by institutional committee for ethics and clinical trial, and obtaining informed consent from the patients, all patients over 18 years of age who were referred to the operating room for vitrectomy surgery were included in this study. Patients with hearing impairments, mental health problems, prolonged use of tranquilizers or analgesics, and those with alcoholism or other illicit drug addictions were excluded from the study. None of the patients received anti-anxiety medication before surgery, and they were only taking medications related to their chronic conditions, such as diabetes and high blood pressure, on the day of surgery. Three patients were excluded from the study due to the use of hypnotics (benzodiazepines), two patients were excluded due to dissatisfaction, and finally, 50 patients were randomized into two equal groups of music (M) and white noise (W) [Figure 1].
As soon as the patients entered the operating room, they underwent standard monitoring with non-invasive blood pressure, electrocardiogram, and pulse oximetry. In addition, the bispectral index was used to monitor the depth of anesthesia and the BIS VISTA device (Aspect Medical Systems, Newton, MA USA) was used to monitor the depth of anesthesia.
General anesthesia was performed in all patients by the same method with intravenous injection of midazolam 0.02 mg/kg and fentanyl 2 micrograms/kg as premedication three minutes before induction. Intravenous injections of lidocaine 1 mg/kg, propofol 1.5 mg/kg, and atracurium 0.5 mg/kg were used for induction. The laryngeal mask was used for airway management in all patients and mechanical ventilation was initiated to maintain ETCO2 close to 30 mmHg. Propofol was used to maintain the BIS at about 50 throughout the procedure. After anesthesia induction, standard music player headphones (BT Trek, Stori Beat, and Move BT) were placed in the correct position for all patients, and the anesthesiologist blindly selected either the music files (M group) or white noise (W group) per random number from the table. Classical music was selected from a previous study. Kuan et al. suggested three unfamiliar relaxing music: Appalachian Spring: Ballet for Martha, by Copeland; Florida Suite: III Sunset-Near the Plantation, by Delius; The Birds: The Dove, by Respighi.[14 (link)] They are introduced as more relaxing than known music. So, we decided to use these three pieces and call them classical music. Loudness was verified using audio samples for patient comfort. To prevent possible hearing damage, the volume was turned up to a maximum of 85 dB by the recommendation of the World Health Organization. The headphones stayed in place until the end of the operation. At the end of the operation, the sound stopped and the headphones were removed. Blood pressure, heart rate, and BIS score were recorded at baseline and every 15 minutes during anesthesia. The amount of propofol used was recorded. Vital signs, pain intensity, the presence of nausea or vomiting, and restlessness were assessed in the recovery room. Pain intensity was measured on a 10-grade visual analog scale (VAS), from no pain (= 0) to maximal possible pain (= 10). Agitation was measured using the Riker Sedation-Agitation Scale [Table 1].[15 (link)]
Data analysis was performed using SPSS software version 17. Due to the normality of the statistical population distribution (confirmed by the Kolmogorov-Smirnov test), the Chi-square test was used to examine qualitative variables and the independent t-test was used to examine quantitative variables and the significance level was less than 0.05 in all cases.
Tajbakhsh A., Salimi S., Daftarian N, & Abtahi D. (2023). Effect of Music During General Anesthesia on Anesthetic Consumption During Vitrectomy Surgery. Advanced Biomedical Research, 12, 59.
Publication 2023
Addictive Behavior Airway Management Alcoholic Intoxication, Chronic Analgesics Anesthesia Anesthesiologist Anti-Anxiety Agents Atracurium Aves Benzodiazepines Blood Pressure Chronic Condition Columbidae Diabetes Mellitus Electrocardiography Fentanyl General Anesthesia Hearing Impairment High Blood Pressures Hypnotics Illicit Drugs Laryngeal Masks Lidocaine Mechanical Ventilation Medical Devices Mental Health Midazolam Nausea Oximetry, Pulse Pain Patients Pharmaceutical Preparations Premedication Propofol Rate, Heart Sedatives Severity, Pain Signs, Vital Sound Surgery, Day Tranquilizing Agents Visual Analog Pain Scale Vitrectomy
3
Postoperative Vomiting Risk Factors
Cited 2 times
The study was approved by the Institutional Review Board of Kaohsiung Chang Gung Memorial Hospital (IRB number: 202001106B0). Informed consent was waived because of the retrospective nature of the study. All methods were performed in accordance with the relevant guidelines and regulations. A total of 1407 surgical patients from the Trauma Department, from January 2018 to December 2018, were enrolled in the study. Information including medical records, anesthesia records retrieved from the hospital’s electronic database, data during a stay in the post-anesthesia recovery unit (PACU), and data from routine postoperative daily visits were collected. A postoperative visit was performed by well-trained nurse anesthetists within 24 h after surgery. Exclusion criteria included age below 20 years old (the legal threshold of adulthood is 20 in Taiwan), total intravenous anesthesia, desflurane anesthesia, or records with missing data. Finally, 855 patients were included in the study for analyses (Figure 1).
Nausea is a subjective and unpleasant sensation, of which no standard is applicable for its measurement. Postoperative vomiting (POV) was used as an endpoint and expressed as a dichotomous unit (vomiters or non-vomiters) in the study. POV was defined as vomiting within 24 h of surgery. Individual variables were stratified into three major categories: patient-related variables, anesthesia-related variables, and postoperative course-related variables. Gender, age, body weight, Apfel score, and ASA physical status were assigned to the patient-related category. The type of surgery, duration of anesthesia, sevoflurane consumption, intraoperative fluid supply, red cell transfusion, urine output, intraoperative opioid consumption, use of antiemetic agents and use of antihypertensive agents were assigned to the anesthesia-related category. Opioid consumption at PACU, opioid consumption at ward, and the use of patient-controlled analgesia (PCA) were assigned to the postoperative course-related category.
All general anesthesia were carried out according to the standard procedure suggested by the hospital [48 (link)]. Briefly, anesthesia was induced with propofol (1 to 2 mg/kg). Use of rocuronium (1 mg/kg) or cis-atracurium (0.2 mg/kg), fentanyl (1 mcg/kg) or alfentanil (10 mcg/kg), sevoflurane (1 to 1.3 MAC) depended on the anesthesiologists’ preferences. We excluded desflurane anesthesia because of the limited number performed. Sevoflurane concentration was titrated against blood pressure and heart rate changes during anesthesia to maintain stable blood pressure and heart rate within 20% of the patient’s normal range or BIS score was kept in the range of 40 to 60 during anesthesia. A fresh gas flow of 50% oxygen with air was kept at 1 L/min. Maintenance of neuromuscular blocking agents or opioids depended on surgical stimulus, anesthesiologists’ preferences, and objective vital signs. The choice and use of antiemetics were determined by anesthesiologists in charge of the anesthesia. Dexamethasone (5 mg) given at induction or Ondansetron (8 mg) given at 30 min at the end of surgery was the standard antiemetic prescription.
Poon Y.Y., Ke T.Y., Hung K.C., Lu H.F., Chiang M.H., Chin J.C, & Wu S.C. (2021). Risk Factors of Postoperative Vomiting in the Eye of “Real-World Evidence”—Modifiable and Clinical Setting-Dependent Risk Factors in Surgical Trauma Patients. Journal of Personalized Medicine, 11(5), 386.
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Publication 2021
Alfentanil Anesthesia Anesthesia, Intravenous Anesthesiologist Antiemetics Antihypertensive Agents Atracurium Blood Pressure Body Weight Desflurane Dexamethasone Fentanyl Gender General Anesthesia Mac-3 Nausea Neuromuscular Blocking Agents Nurse Anesthetists Ondansetron Operative Surgical Procedures Opioids Oxygen Patient-Controlled Analgesia Patients Physical Examination Propofol Rate, Heart Red Blood Cell Transfusion Rocuronium Sevoflurane Signs, Vital Urine Wounds and Injuries
4
Desflurane versus Propofol in Anesthesia
Cited 2 times
No anxiolytic premedication was given to the patient before surgery. Anaesthetic induction was performed with Propofol + Sufentanil + Atracurium. Patients had standard monitoring including depth of anaesthesia using the Bispectral (BIS®) index. Hypothermia was prevented by using warming blankets.
All patients were intubated and ventilated with a mixture of O2/N2O: 50/50%. Fluid loading was achieved with crystalloids and/or colloids depending on requirements.
According to randomization, patients were allocated to receive either Desflurane (Group D) or Propofol (Group P) for anaesthesia maintenance.

Group D: Desflurane

Induction with a bolus of Propofol 2–3 mg/kg

Maintenance with a closed circuit of Desflurane with minimal alveolar concentration adapted to maintain a BIS value between 40 and 60.

Group P: Propofol

Target controlled administration of Propofol at 2 and 4 μg/ml to be adjusted to maintain a BIS value between 40 and 60.

Supplemental boluses of Sufentanil and Atracurium were given as required. At the end of surgery (T0), the patient was transferred to the post-anaesthesia care unit (PACU). Tracheal extubation was carried out when the patient was conscious, with a respiratory rate above 12.min− 1, a core temperature > 36 °C, and without residual muscle weakness (residual curarization was assessed with Double-Burst Stimulation and antagonized if necessary).
Post-operative pain intensity at rest was evaluated using the Numerical Rating Scale (NRS) with 0 = no pain and 10 = maximal imaginable pain intensity. Post-operative analgesia was multimodal. The use of locoregional techniques for post-operative analgesia was encouraged (nerve block, trunk block +/− placement of a perineural catheter +/− wound infiltration). During the stay in PACU, if NRS ≥ 3, morphine was administered by titration (bolus of 1 mg IV repeated every 5 min until NRS at rest < 3).
After arrival in the PACU, the Aldrete score was checked every 5 min. Once the score of ≥9 had been attained, the cognitive tests were carried out for a second time.
The data from these tests was collected by the same investigator as the day before surgery in the case report form.
Robert C., Soulier A., Sciard D., Dufour G., Alberti C., Boizeau P, & Beaussier M. (2021). Cognitive status of patients judged fit for discharge from the post-anaesthesia care unit after general anaesthesia: a randomized comparison between desflurane and propofol. BMC Anesthesiology, 21, 76.
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Publication 2021
Aftercare Anesthesia Anesthetics Anti-Anxiety Agents Atracurium Catheter Obstruction Cognitive Testing Colloids Consciousness Desflurane Management, Pain Morphine Multimodal Imaging Muscle Weakness Nerve Block Operative Surgical Procedures Pain Patients Premedication Propofol Respiratory Rate Severity, Pain Solutions, Crystalloid Sufentanil Surgery, Day Titrimetry Tracheal Extubation Wounds
5
Volatile Anesthetic Consumption in BIS-Guided vs. Standard Anesthesia
Cited 2 times
Before beginning, the study was approved by the Institutional Review Board of Kaohsiung Chang Gung Memorial Hospital (IRB number: 201800207B0). Informed consent was waived because of the retrospective nature of the study. All methods were performed in accordance with the relevant guidelines and regulations. We retrieved anesthesia records from May 1st, 2017 to Aug 31st, 2017, from the hospital’s database, and a total of 13,027 general anesthesia records were collected. Exclusion criteria included ambulatory surgeries, sedated endoscopy, pediatric surgeries, a limited number of uncommon procedures (case numbers less than 50), and any record with missing data. Recruited patients received either sevoflurane or desflurane as their primary general anesthetic. The general anesthesia was carried out in semiclosed circuit with fresh gas flow of 1 L/min. The anesthesia machines automatically record the consumption of volatile anesthetics at the conclusion of anesthesia. Hourly consumption was calculated depending on the volatile anesthetics consumption and the total anesthesia time. Postoperative daily visit was performed by the well-trained nurse anesthetists and the postoperative events within 72 h including intraoperative awareness, headache or dizziness, postoperative nausea and vomiting, respiratory event, cerebrovascular event, and patients’ satisfaction were recorded.
We divided patients into two major groups as the BIS-guided anesthesia group and the standard anesthesia practice group, and these two groups formed the basis for comparing the consumption of volatile anesthetics in different patients. To elucidate the effect of anesthesia time in these two major groups, we allocated patients according to anesthesia time, namely 2-h, 4-h, 6-h, 8-h, and 10-h. To elucidate the effect of age on the consumption of volatile anesthetics in these two major groups, we stratified patients into four age groups, 21–40 years, 41–60 years, 61–80 years, and over 80 years for comparison.
As a standard practice in our hospital, general anesthesia was induced with propofol (1 to 2 mg/kg). The use of rocuronium (1 mg/kg) or cis-atracurium (0.2 mg/kg), fentanyl (1 mcg/kg) or alfentanil (10 mcg/kg), desflurane (1 to 1.3 MAC) or sevoflurane (1 to 1.3 MAC) depends on the anesthesiologists’ preferences. Nitrous oxide, midazolam or other amnestic drugs except propofol was not used in induction and maintenance of general anesthesia in our study. The patient decided whether or not to utilize BIS-guided anesthesia. In the BIS-guided group, the BIS score was kept in the range of 40 to 60 during anesthesia. In the standard anesthesia practice group, volatile anesthetics were titrated against blood pressure and heart rate changes during anesthesia to maintain stable blood pressure and heart rate within 20% of the patient’s normal range. A fresh gas flow of 50% oxygen with air was kept to 1 L/min. Maintenance of neuromuscular blocking agents or opioids depended on surgical stimulus, anesthesiologists’ preferences, and objective vital signs (more than 20% increase in heart rate, systolic blood pressure and mean arterial pressure). The total consumption of volatile anesthetics was automatically recorded by the anesthesia machine Avance (GE Datex-Ohmeda, Madison, WI), S/5 ADU(GE Datex-Ohmeda, Madison, WI), Carestation 620 (GE Datex-Ohmeda, Madison, WI), or Primus (Drägerwerk, AG, Lübeck, Germany).
Poon Y.Y., Chang H.C., Chiang M.H., Hung K.C., Lu H.F., Wang C.H., Chin J.C, & Wu S.C. (2020). “A real-world evidence” in reduction of volatile anesthetics by BIS-guided anesthesia. Scientific Reports, 10, 11245.
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Publication 2020
Age Groups Alfentanil Ambulatory Surgical Procedures Anesthesia Anesthesiologist Anesthetic Effect Anesthetics Atracurium Blood Pressure Desflurane Endoscopy Fentanyl General Anesthesia Headache Mac-3 Midazolam Neuromuscular Blocking Agents Nurse Anesthetists Operative Surgical Procedures Opioids Oxide, Nitrous Oxygen Patients Pharmaceutical Preparations Postoperative Nausea Propofol Rate, Heart Respiratory Rate Rocuronium Sevoflurane Signs, Vital Systolic Pressure

Most recents protocols related to «Atracurium»

1
Electrical Auditory Brainstem Response Recording Protocol
The EABR was recorded by Neuro-Audio NET1.0.103.3. (Neurosoft, Ivanovo, Russia).
The recording electrode, the ground electrode and the reference electrode were
body surface button electrodes and were placed in the middle of the forehead,
between the eyebrows, and about 1 cm in front of the tragus of the operative
ear, respectively. The electrical stimulation was generated from an EMG external
electric stimulator (Neurosoft, Ivanovo, Russia). The facial nerve stimulation
probe (Medtronic, Minneapolis, USA) was selected as the stimulation positive
electrode. Its surface was coated with Parylene insulating coating except for
the exposed tail end of the electrode and the diameter was 500
μm. A stainless steel needle electrode was used as the
reference electrode and was placed in the coarse protuberance of the occipital
bone at the operation side. The EABR output signal was filtered online with a
band-pass of 0.1–3 kHz and was averaged from 512 sweeps at each stimulus level
with a time window of 15 ms. The electrical pulse was the alternating wave with
100-μs duration and was delivered at a rate of 21 Hz.
Electrode impedances were less than 3 kΩ.
All surgical procedures were performed via a mastoidectomy. Posterior tympanotomy
was performed through the facial recess. Meticulous hemostasis could be achieved
by using diamond burs. After the RWN was exposed, we injected patients with
muscle relaxant cis-atracurium at 0.5 mg/kg according to the body weight to
reduce the interference of muscle activity from EABR signals. During the first
EABR recording, the stimulation probe was placed on the surface of the RWN.
Then, a diamond bur was used to remove the RWN and maximally expose the RWM. We
performed the second EABR recording by placing the stimulation probe on the
surface of the RWM. The initial electrical stimulation intensity for the EABR
was 2.0 mA. To assess the EABR threshold, namely the minimum stimulation
intensity eliciting eIII or eV, we increased or decreased the stimulation
intensity in a first step of 0.5 mA followed by a smaller step of 0.1 mA until
the eIII or eV appeared or disappeared. The maximum stimulation intensity was
3.0 mA. The EABR waveform for each stimulation intensity was averaged by 512
epochs and detected visually. Each test of the EABR for the RWN or RWM
stimulation lasted 3–5 min.
Chen L., Zhang J.G., Zhu H.Y., Hou X.Y., Tang Z.Q., Sun J.W., Sun J.Q, & Guo X.T. (2023). Electrically Evoked Auditory Brainstem Responses in Children Fitted with Hearing Aids Prior to Cochlear Implantation. Trends in Hearing, 27, 23312165221148846.
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Publication 2023
Atracurium Body Weight Diamond Electricity Eyebrows Face Facial Nerves Hemostasis Impedance, Electric Mastoidectomy Muscle Tissue Needles Operative Surgical Procedures parylene Patients Pulse Rate Stainless Steel Stimulations, Electric Tail
2
Perioperative Hemodynamic Optimization using ΔPP and Stroke Volume
We placed all patients on standard non-invasive monitors. Anesthesia was induced according to the standard operating procedures [SOP] of our hospital using 1.5–2.5 mg/kg body weight (BW) Propofol, 0.2–0.5 µg/kg BW Sufentanil and 0.5–0.6 mg/kg ideal body weight (IBW) Atracurium or 0.6 mg/kg IBW Rocuronium at the discretion of the attending anesthesiologist. Maintenance of anesthesia was accomplished using Sevoflurane adjusted to age-corrected mean alveolar concentration. Analgesia was adapted to meet patient individual demands using additional Sufentanil boluses of 5–10 µg. A non-opioid analgetic was administered 30 min before the end of the procedure for early post-operative analgesia.
An arterial cannula was placed in the radial artery for continuous, invasive blood pressure monitoring (Philips IntelliVue MX700, Philips Medizin Systeme GmbH, Boeblingen, Germany). Invasive blood pressure monitoring was calibrated by placing the pressure transducer at the level of the right atrium and venting the transducer to atmospheric pressure for reference. ∆PP was calculated as ΔPP[%]((PPmax-PPmin)/([PPmax+PPmin]/2))×100
where PPmax and PPmin are the maximum and minimum pulse pressure during one respiratory cycle. ΔPP measurements were calculated from beat-to-beat arterial pressure values and reported as the average value of the last 32 s.
Stroke volume was measured by esophageal doppler monitoring (CardioQ-ODM®, Deltex Medical Ltd, Chichester, UK). The tip of the doppler probe was placed in the pars thoracica of esophagus at the level of the descending aorta. Stroke volume was calculated by the product of stroke distance (area of the doppler derived velocity–time waveform) and aortic cross-sectional area [12 (link)].
Patients were mechanically ventilated with a tidal volume ≥ 8 ml/kg IBW using pressure-controlled ventilation. Positive end-exspiratory pressure was kept between 5–8 mbar, respiratory rate was set to 12–16 min−1 and fraction of inspired oxygen (FiO2) was set to keep oxygen saturation above 95% according to departmental standard operating procedures. All settings and target values were continuously adapted to patient characteristics and clinical situation using repetitive blood gas analyses.
In case of possible hypovolemia a fluid bolus of 7 ml/kg IBW was administered at the discretion of the attending anesthesiologist.
Trigger for fluid bolusing were:

Difference in pulse pressure [∆PP] ≥ 9% [13 (link), 14 (link)] and/or

corrected flow time [FTc] ≤ 350 ms [15 (link)]

An increase in stroke volume ≥ 10% following the fluid bolus was considered ‘fluid responsive’.
Fukui K., Wirkus J.M., Hartmann E.K., Schmidtmann I., Pestel G.J, & Griemert E.V. (2023). Non-invasive assessment of Pulse Wave Transit Time (PWTT) is a poor predictor for intraoperative fluid responsiveness: a prospective observational trial (best-PWTT study). BMC Anesthesiology, 23, 60.
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Publication 2023
Anesthesia Anesthesiologist Aorta Arteries Arteries, Radial Atracurium Atrium, Right Blood Gas Analysis Blood Pressure Body Weight Cannula Cerebrovascular Accident Descending Aorta Esophagus Ideal Body Weight Management, Pain Opioids Oxygen Oxygen Saturation Patient Monitoring Patients Poly(ADP-ribose) Polymerases Precipitating Factors Pressure Propofol Pulse Pressure Respiratory Rate Rocuronium Sevoflurane Stroke Volume Sufentanil Thoracica Tidal Volume Transducers, Pressure
3
Standardized RALP Anesthesia Protocol
A standardised anaesthesia protocol for drug administration during RALP was exclusively conducted by three anaesthesiologists throughout the entire study. Drug dosing was based on the calculated PBW (PBW formula: PBW [men] = 50 + 0.91 × [cm of height—152.4] in kg) [17 (link)]. Anaesthesia was induced with sufentanil (initial 0.5 µg/kg bolus), propofol (2–3 mg/kg) and atracurium (0.5 mg/kg). After tracheal intubation with a 7.5 mm or an 8.0 mm endotracheal tube, anaesthesia was maintained with sufentanil (repetition of 10 µg every 30 to 45 min until 30 min before the end of surgery) and propofol (4–6 mg/kg/h) as total intravenous anaesthesia (TIVA). TIVA was used as standard anaesthesia for RALP to minimise the influence on pulmonary function by volatile anaesthetics. A Bispectral Index™ (BIS Vista Monitor, Aspect Medical, Germany) between 40 and 50 was upheld during anaesthesia. Invasive blood pressure was measured directly after the induction of anaesthesia using a radial artery catheter. All patients were placed by default in STP to check the correct positioning and solid fixation on the operating table. In this context, the individualised PEEP group received one recruitment manoeuvre (RM) followed by a decremental PEEP titration in STP.
The RM was performed in volume-controlled mode and consisted of 10 respiratory cycles with a PEEP level of 22 cmH2O, a peak inspiratory pressure of 40 cmH2O and a ventilation frequency of 6 breaths per min with an I/E of 1:2. For the decremental PEEP titration PEEP was set to 20 cmH2O and decreased stepwise by 2 cmH2O every 3 min. At each PEEP step, the best lung compliance value was observed, and this individual PEEP level was maintained throughout mechanical ventilation during surgery. No RM were employed in the standard PEEP group.
During RALP, the target values for SpO2 were defined as higher than 92% and those of mean arterial pressure (MAP) as 60 mmHg. Otherwise, FiO2 or noradrenaline concentration was adapted. All patients received volume-controlled ventilation with PEEP according to the levels predefined for the respective group, using an inspiration-to-expiration ratio of 1:1, a basic respiratory rate of 12 and a constant VT of 7–8 mL/kg PBW. At the beginning of RALP, pneumoperitoneum was created by intraperitoneal insufflation of CO2 to a standard value of 15 mmHg with the patient in supine position. Subsequently, each patient was consequently placed in 45 degrees STP. Surgery was exclusively conducted by three urologists. Neuromuscular transmission was monitored with a peripheral nerve stimulator to maintain one twitch of the train-of-four (TOF). Relaxation with rocuronium was finished 45 min before the end of surgery. For extubation, the TOF ratio had to be >0.9 at the end of RALP. Individualised high PEEP values were reduced to 8 cmH2O at the end of surgery after positioning the patient in supine position prior to extubation.
Blecha S., Hager A., Gross V., Seyfried T., Zeman F., Lubnow M., Burger M, & Pawlik M.T. (2023). Effects of Individualised High Positive End-Expiratory Pressure and Crystalloid Administration on Postoperative Pulmonary Function in Patients Undergoing Robotic-Assisted Radical Prostatectomy: A Prospective Randomised Single-Blinded Pilot Study. Journal of Clinical Medicine, 12(4), 1460.
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Publication 2023
Anesthesia Anesthesia, Intravenous Anesthesiologist Anesthetics Arteries, Radial Atracurium Blood Pressure Catheters Inhalation Insufflation Intubation, Intratracheal Lung Lung Compliance Mechanical Ventilation Norepinephrine Operating Tables Operative Surgical Procedures Patients Peripheral Nerves Pharmaceutical Preparations Pneumoperitoneum Positive End-Expiratory Pressure Pressure Propofol Respiratory Rate Rocuronium Saturation of Peripheral Oxygen Sufentanil Titrimetry Tracheal Extubation Transmission, Communicable Disease Treatment Protocols Urologists
4
Multimodal Anesthesia Management Protocol
After sufficient oxygenation and nitrogen removal, the two groups received the same scheme of intravenous inhalation combined with endotracheal intubation general anesthesia: propofol 50–80 μg·kg-1·min-1 and remifentanil 0.05–0.15 μg·kg-1·min-1 intravenous pumping, and sevoflurane 1–2% inhalation maintenance. According to the administration time and muscle relaxation in the operation area, 0.1 mg/kg atracurium CIS sulfonate and 5 μg sufentanil were added intermittently to maintain a bispectral index (BIS) value of 45–60, and the fluctuations of blood pressure (BP) and heart rate (HR) were within 20% of the baseline value. Both groups were given 5 mg of tropisetron intravenously after the operation. After surgery, the participants were transferred to the post-anesthesia care unit (PACU), where they achieved complete anesthesia recovery before transfer to the surgical ward.
Collectible 200 mg was given orally every 12 h. After tracheal extubation, PCIA was administered 48 h after surgery. The PCIA formulae were sufentanil 100 μg and tropisetron 10 mg, diluted to 100 mL with 0.9% normal saline; the background dose was 1 mL/h, the controlled additional dose (PCA) was 2 mL, and the locking time was 10 min. In addition, parecoxib sodium 40 mg was injected intravenously into patients with a numeric rating scale (NRS) score of ≥5. Patients who developed undesirable opioid side effects (nausea and vomiting) were given tropisetron 5 mg intravenously every 6 h.
Hu L., Shen Z., Pei D., Sun J., Zhang B., Zhu Z., Yan W., Zhou H, & An E. (2023). Ultrasound-Guided Modified Thoracolumbar Fascial Plane Block in Tianji Robot-Assisted Lumbar Internal Fixation: A Prospective, Randomized, and Non-Inferiority Study. Journal of Pain Research, 16, 543-552.
Publication 2023
Alkanesulfonates Anesthesia Atracurium Blood Pressure Cell Respiration General Anesthesia Inhalation Intubation, Intratracheal Nausea Nitrogen Normal Saline Operative Surgical Procedures Opioids parecoxib sodium Patients Propofol Rate, Heart Relaxations, Muscle Remifentanil Sevoflurane Sufentanil Tracheal Extubation Tropisetron
5
Ciprofol Dose-Dependent Anesthetic Induction
Patients in each of the three groups were routinely administered 10 mL/kg/h lactated Ringer's solution in an open hand vein upon admission, and the mean arterial pressure (MAP), electrocardiogram, pulse oxygen saturation (SpO2), and bispectral index (BIS) value (ConView YY‐106, Pearl Care) were continuously monitored with a multifunctional monitor. After the monitoring was completed, all patients underwent radial artery puncture and catheterization under local anesthesia to monitor the real‐time invasive arterial blood pressure, and efforts were made to relieve any nervousness. After lying down for 10 min, anesthesia was induced after the patient was quiet and the vital signs were stable. All patients underwent nitrogen removal and were given oxygen for 3 min (flow rate of 5 L/min), and 0.4 μg/kg sufentanil (Hubei, Yichang Humanwell Pharmaceutical Co., Ltd.) was administered by slow intravenous infusion. After 2 min, patients in group C1, group C2, and group C3 were slowly injected with 0.2, 0.3, and 0.4 mg/kg ciprofol (Liaoning HISCO Pharmaceutical Co., Ltd.), respectively, for 30 s. A dose of 0.2 mg/kg cis‐atracurium (Jiangsu Hengrui Pharmaceutical Co., Ltd.) was then administered. After all of the drugs had been injected after approximately 2–3 min, muscle relaxation was achieved and tracheal intubation was performed. Endotracheal intubation was required to be successful in one attempt. After successful intubation, mechanical ventilation was connected to the anesthesia machine, and respiratory parameters were adjusted. Continuous inhalation of 1.5% sevoflurane (Shanghai Hengrui Pharmaceutical Co., Ltd.) was administered to maintain anesthesia. During induction of anesthesia, if the BIS value continued to be greater than 60, 0.1 mg/kg ciprofol was administered each time for remedial sedation. The duration of administration was 10 s, and each additional interval was >1 min until the BIS value stabilized below 60.
The following evaluation time points were defined: T0: Admission (basal); T1: Before endotracheal intubation; T2: 10 s after endotracheal intubation; T3: 3 min after endotracheal intubation; T4: 5 min after endotracheal intubation.
Duan G., Lan H., Shan W., Wu Y., Xu Q., Dong X., Mei P., You M., Jin L, & Wu J. (2023). Clinical effect of different doses of ciprofol for induction of general anesthesia in elderly patients: A randomized, controlled trial. Pharmacology Research & Perspectives, 11(2), e01066.
Publication 2023
Anesthesia Arteries, Radial Atracurium Catheterization Electrocardiography Inhalation Intravenous Infusion Intubation Intubation, Intratracheal Lactated Ringer's Solution Local Anesthesia Mechanical Ventilation Nervousness Nitrogen Oxygen Oxygen Saturation Patients Pharmaceutical Preparations Pulse Rate Punctures Relaxations, Muscle Respiratory Rate Saturation of Peripheral Oxygen Sedatives Sevoflurane Signs, Vital SOCS2 protein, human Sufentanil Veins

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More about "Atracurium"

Atracurium, a nondepolarizing neuromuscular blocking agent (NMBA), is a key pharmaceutical used for muscle relaxation during surgery and mechanical ventilation.
This bisquarternary benzylisoquinolinium compound works by competitively inhibiting acetylcholine at the neuromuscular junction, effectively blocking muscle contractions.
Atracurium has a rapid onset and intermediate duration of action, making it a popular choice for healthcare professionals.
It undergoes spontaneous degradation at physiological pH and temperature via Hofmann elimination, a unique metabolic pathway that contributes to its favorable pharmacokinetic profile.
The use of Atracurium helps facilitate tracheal intubation and improve surgical conditions by providing effective muscle relaxation.
It is often compared to other NMBAs like Substance P, Propofol, and Cortistatin, each with their own nuanced mechanisms and applications.
In addition to its primary use in anesthesia, Atracurium has also been studied for its potential applications in conditions like PAMP (9-20)-induced bronchoconstriction and Leuprolide-induced muscle spasms.
Researchers continue to explore the versatility and optimization of this important pharmaceutical agent.
When selecting Atracurium for your research protocols, be sure to consult the latest literature, pre-prints, and patents to identify the best practices and products.
PubCompare.ai's AI-driven platform can help you streamline this process and enhance the reproducibility of your work.