Neuromuscular" blockade, reversal

Hasfurther DL, Bailey PL. Failure of neuromuscular blockade reversal after rocuronium in a patient who received oral neomycin. Can J/fnoesdi (1996) 43,617-20. 

FernandezMere LA, Alvarez-Bianco M. Sugammadex. Nuevo farmaco reversor del bloqueo neuromuscular. [Sugammadex, a novel drug for neuromuscular blockade reversal.] Rev Esp Anestesiol Reanim 2010 57(2) 95-102. 

Neuromuscular blockade or respiratory paralysis may occur after administration of the aminoglycosides Therefore, it is extremely important that any symptoms of respiratory difficulty be reported immediately. If neuromuscular blockade occurs, it may be reversed by the administration of calcium salts but mechanical ventilation may be required. 

Neuromuscular blocking agents Do not use flumazenil until the effects of neuromuscular blockade have been fully reversed. 

Reversal of neuromuscular blockade Adults and children, 0.2 mg for each 1 mg neostigmine or 5 mg pyridostigmine. Administer IV simultaneously. 

Adults. 3 g PO q6h x 4 PRN Supl 1-2 g IM or IV repeat PRN Preeclampsia/pre-mature labor 4 g load then g/h IV inf Cardiac arrest 1-2 g IV push (2-4 mL 50% soln) in 10 mL DjW AMI Load 1-2 g in 50-100 mL D5W, over 5-60 min IV then 0.5-1.0 g/h IV up to 24 h (ECC 2005) Feds. 25-50 mg/kg/dose IM or IV q4-6h for 3-4 doses repeat PRN dose w/ low urine output or renal insuff Caution [B, +] Contra Heart block, renal failure Disp Inj 10, 20, 40, 80, 125, 500 mg/mL bulk powder SE CNS depression, D, flushing, heart block Interactions T CNS depression W/ antidepressants, antipsychotics, anxiolytics, barbiturates, hypnotics, narcotics EtOH T neuromuscular blockade Wf aminoglycosides, atracurium, gallamine, pancuronium, tubocurarine, vecuronium EMS Check for absent patellar reflexes this may indicate tox may cause hypokalemia (flattened T waves) and hypocalcemia OD May cause hypotension, resp arrest, T PR, QRS, and QT interval, AV block, and cardiac arrest calcium salts can be given to reverse resp depression... 

Reversal of nondepolarizing neuromuscular Blockade IV 10-20 mg with, or shortly after, 0.6-1.2 mg atropine sulfate or 0.3-0.6 mgglycopyrrolate. 

Sevan DR, Donati F, Kopman AF. Reversal of neuromuscular blockade. Anesthesiol 1992 77 785-805. 

A novel cyclodextrin reversal drug, sugammadex, has been submitted for FDA approval. It can rapidly inactivate steroidal neuromuscular blocking drugs by forming an inactive complex, which is excreted in the urine. This process allows the practitioner to rapidly reverse even profound degrees of neuromuscular blockade produced by rocuronium and vecuronium at the end of the surgical procedure. 

Nicholson WT, Sprung J, Jankowski CJ Sugammadex a novel agent for the reversal of neuromuscular blockade. 

Sacan O, Klein K, White PF Sugammadex reversal of rocuronium-induced neuromuscular blockade A comparison with neostigmine-glycopyrrolate and edrophonium-atropine. Anesth Analg 2007 104 569. [PMID 17312210]... 

In very high doses, aminoglycosides can produce a curare-like effect with neuromuscular blockade that results in respiratory paralysis. This paralysis is usually reversible by calcium gluconate (given promptly) or neostigmine. Hypersensitivity occurs infrequently. 

Atropine Generic Peptic ulcer, irritable bowel syndrome, neurogenic bladder, bronchospasm, preoperative antisecretory agent, cardiac arrhythmias (e.g., sinus bradycardia, postmyocardial infarction, asystole], reversal of neuromuscular blockade, antidote to cholinesterase inhibitor poisoning... 

Glycopyrrolate Robinul Peptic ulcer, preoperative antisecretory agent, antidiarrheal, reversal of neuromuscular blockade... 

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