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Titolo:
ADVERSE-EFFECTS OF NEUROMUSCULAR BLOCKERS AND THEIR ANTAGONISTS
Autore:
NAGUIB M; MAGBOUL MMA;
Indirizzi:
KING KHALID UNIV HOSP,FAC MED,DEPT ANAESTHESIA,POB 7805 RIYADH 11472 SAUDI ARABIA
Titolo Testata:
Drug safety
fascicolo: 2, volume: 18, anno: 1998,
pagine: 99 - 116
SICI:
0114-5916(1998)18:2<99:AONBAT>2.0.ZU;2-P
Fonte:
ISI
Lingua:
ENG
Soggetto:
CRITICALLY ILL PATIENTS; MUSCARINIC ACETYLCHOLINE-RECEPTOR; NONDEPOLARIZING MUSCLE-RELAXANTS; HUMAN PLASMA CHOLINESTERASE; THREATENING ANAPHYLACTOID REACTIONS; HISTAMINE N-METHYLTRANSFERASE; INTENSIVE-CARE UNIT; MALIGNANT HYPERTHERMIA; BLOCKING-AGENTS; INTRAOCULAR-PRESSURE;
Tipo documento:
Review
Natura:
Periodico
Settore Disciplinare:
Science Citation Index Expanded
Science Citation Index Expanded
Science Citation Index Expanded
Citazioni:
163
Recensione:
Indirizzi per estratti:
Citazione:
M. Naguib e M.M.A. Magboul, "ADVERSE-EFFECTS OF NEUROMUSCULAR BLOCKERS AND THEIR ANTAGONISTS", Drug safety, 18(2), 1998, pp. 99-116

Abstract

Among all the drugs used for general anaesthesia, neuromuscular blockers appear to play a prominent role in the incidence of severe adversereactions. Tt now seems likely that most serious adverse drug reactions occurring during anaesthesia are immunological in type. The frequency of life-threatening anaphylactic or anaphylactoid reactions occurring during anaesthesia has been estimated to be between 1 in 1000 and 1in 25000 anaesthetic procedures. with the neuromuscular blockers being in involved in 80% of cases. The mortality from such serious reactions is reported to be in the range of 3.4 ro 6%. The highly immunogenicdrug, suxamethonium chloride (succinylcholine), was found to be the most hazardous agent. Drug-specific immunoglobulin E antibodies to suxamethonium chloride and other neuromuscular blockers have been demonstrated. This sensitivity to neuromuscular blockers seems to be a long-lasting phenomenon. During anaesthesia, the clinical features of an allergic reaction are often masked. Tachycardia and circulatory collapse may be the only signs of an allergic reaction, and they are easily misdiagnosed. Bronchospasm is reported to be present in about 40% of cases. Successful management of these patients includes stabilisation during the acute reaction and avoidance of future reactions. The latter is based on the identification of the causative drug and potentially cross-reacting compounds. The use of suxamethonium chloride is associated with many other adverse effects, such as fasciculations, myalgia, potassium release, changes in the heart fate, increases in intragastric and intraocular pressures. and malignant hyperthermia. Because of the dangers of hyperkalaemic cardiac arrest after suxamethonium chloride administration in children with unrecognised muscular dystrophy, there have now been moves to limit the use of this drug in children. Although neuromuscular blockers ar designed tu specifically block nicotinic cholinergic receptors at the neuromuscular junction: many bind to muscarinic cholinergic receptors on ganglia and smooth muscle, and alter parasympathetically mediated heart rate and airway calibre, Most benzylisoquinolinium muscle relaxants call induce histamine release. especiallywhen they are administered rapidly, which can lead to disturbances ofcardiovascular function. In addition, nondepolarising neuromuscular blockers have been implicated in causing,generalised weakness followingtheir ion term administration to patients on an intensive care unit. The problem with these adverse drug reactions is their unpredictable nature. Therefore, prompt recognition with appropriate therapy call help to improve the outcome.

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Documento generato il 23/01/21 alle ore 02:04:17