Sugammadex is a modified gamma-cyclodextrin that is used to reverse steroidal non-depolarizing neuromuscular blocking drugs rocuronium and vecuronium. Residual neuromuscular blockade is common after surgery, with an estimated 30 to 60% incidence in the recovery room.
This document outlines sugammadex, a drug that reverses the effects of neuromuscular blocking agents like rocuronium and vecuronium. It works by encapsulating the blocking agents. The document discusses sugammadex's mechanism of action, pharmacokinetics, dosing, side effects, populations for use, and references. Sugammadex provides very rapid and reliable reversal of neuromuscular blockade from rocuronium and can reverse profound blockade when other drugs cannot. However, it is also very expensive.
DEXMEDETOMIDINE ALONE OR WITH KETAMINE IN ADDITION TO 2.pptxAfaq Hussain
This randomized controlled trial compared the effects of dexmedetomidine (DMM) alone versus DMM plus ketamine for postoperative sedation in 40 cardiac surgery patients. The study found that patients who received DMM plus ketamine had significantly shorter duration of mechanical ventilation, earlier time to extubation, and lower total fentanyl dose compared to patients who received DMM alone. Both groups had stable hemodynamic parameters and similar sedation scores. The combination of DMM and ketamine may provide earlier recovery after cardiac surgery compared to DMM alone.
Ropivacaine is a new local anesthetic with less cardiovascular and neurological toxicity compared to bupivacaine. This study evaluated the effectiveness of spinal anesthesia using 14 mg of ropivacaine with 30 μg of fentanyl for total abdominal hysterectomies. Results showed that ropivacaine provided effective sensory blockade and muscle relaxation for surgery. Side effects like hypotension and nausea were mild and managed easily. Ropivacaine is concluded to be suitable for short gynecological surgeries allowing for early patient recovery and mobilization.
This document discusses the use of muscle relaxants in anesthesia and the potential role of sugammadex as a reversal agent. It provides background on why muscle relaxants are used, types of muscle relaxants, and current problems with reversal agents. It then summarizes research on sugammadex, which appears to be a more effective reversal agent than anticholinesterases, allowing faster recovery from neuromuscular blockade. Sugammadex may allow safer use of muscle relaxants and replace agents like suxamethonium, but economic factors will also influence its adoption.
Lecture to FACE Conference London by Dr. Patrick Treacy about split face study comparing two recent CO2 resurfacing lasers. Lasers compared were the Lumenis ActiveFx and the Deka SmartXide DOT
Dr. Niranjan Kumar Verma¹*, Dr. Mahesh Kumar²
¹Professor, Department of Anaesthesiology, JLN Medical College & Hospital, Bhagalpur, India
²Assistant Professor, Department of Anaesthesiology, JLN Medical College & Hospital, Bhagalpur, India
*Address for Correspondence: Dr. Niranjan Kumar Verma, Professor, Department of Anaesthesiology, JLN Medical
College & Hospital, Bhagalpur, India
Received: 04 Sept 2016/Revised: 28 Sept 2016/Accepted: 18 Oct 2016
ABSTRACT- BACKGROUND & OBJECTIVES: Control of post spinal shivering is essential for optimal
peri-operative care as shivering is a cause of discomfort and dissatisfaction in patients undergoing operations under spinal
anaesthesia. The aim of the study is to assess the efficacy and safety of intravenous Clonidine, Dexmedetomidine and
Tramadol in the treatment of post spinal intra-operative shivering.
MATERIALS AND METHODS: In this prospective, double blind, randomized study, 90 ASA grade I and II patients of
patients aged 18 – 50 rears, scheduled for various routine surgical procedures under spinal anaesthesia with hyperbaric
Bupivacaine and who developed shivering were selected. The patients were divided into three groups of 30 each.
Group- C (n=30) comprised of the patients who received Clonidine 0.5mcg/kg intravenously, Group-D (n=30) who
received Dexmedetomidine 0.5mcg/kg IV and Group T (n=30) receiving Tramadol 2 mg/kg (maximum 100mg) IV. The
efficacy and response rate of the study drugs were evaluated and recorded. Side effects like, nausea, vomiting,
hypotension, bradycardia, sedation and headache, if present, were recorded. All data were analyzed using Chi-square test
and student-t test and expressed in >0.05, (which is insignificant) and < 0.05, (which is significant differences).
RESULTS: There were significant differences in the total response rate between the drugs (p > 0.05), Tramadol showing
the highest response rate (100%). Time taken from the start of treatment to cessation of shivering was significantly less
(p<0.05) in Dexmedetomidine group, but Tramadol group shows complete control of post spinal shivering with none or
lesser and mild degree of side effects with a single dose.
CONCLUSION: Complete control of post spinal intra-operative shivering with less or no severe side effects could be
achieved with Tramadol in comparisons to clonidine and Dexmedetomidine.
Key-words- Post spinal Shivering, Clonidine, Dexmedetomidine, Tramadol
The document summarizes the properties and clinical uses of dexmedetomidine, a highly selective alpha-2 adrenergic receptor agonist. It was first synthesized in the 1980s and approved by the FDA in 1999 for sedation in intensive care units. Dexmedetomidine has sedative, anxiolytic, and analgesic effects. It provides a unique sedation state resembling natural sleep and reduces opioid requirements. Clinical trials demonstrate dexmedetomidine results in shorter ICU and ventilator times compared to midazolam. Adverse effects include hypotension and bradycardia. The document reviews the pharmacokinetics, mechanisms of action, clinical effects, indications and trials of dexmedetomidine
This document outlines sugammadex, a drug that reverses the effects of neuromuscular blocking agents like rocuronium and vecuronium. It works by encapsulating the blocking agents. The document discusses sugammadex's mechanism of action, pharmacokinetics, dosing, side effects, populations for use, and references. Sugammadex provides very rapid and reliable reversal of neuromuscular blockade from rocuronium and can reverse profound blockade when other drugs cannot. However, it is also very expensive.
DEXMEDETOMIDINE ALONE OR WITH KETAMINE IN ADDITION TO 2.pptxAfaq Hussain
This randomized controlled trial compared the effects of dexmedetomidine (DMM) alone versus DMM plus ketamine for postoperative sedation in 40 cardiac surgery patients. The study found that patients who received DMM plus ketamine had significantly shorter duration of mechanical ventilation, earlier time to extubation, and lower total fentanyl dose compared to patients who received DMM alone. Both groups had stable hemodynamic parameters and similar sedation scores. The combination of DMM and ketamine may provide earlier recovery after cardiac surgery compared to DMM alone.
Ropivacaine is a new local anesthetic with less cardiovascular and neurological toxicity compared to bupivacaine. This study evaluated the effectiveness of spinal anesthesia using 14 mg of ropivacaine with 30 μg of fentanyl for total abdominal hysterectomies. Results showed that ropivacaine provided effective sensory blockade and muscle relaxation for surgery. Side effects like hypotension and nausea were mild and managed easily. Ropivacaine is concluded to be suitable for short gynecological surgeries allowing for early patient recovery and mobilization.
This document discusses the use of muscle relaxants in anesthesia and the potential role of sugammadex as a reversal agent. It provides background on why muscle relaxants are used, types of muscle relaxants, and current problems with reversal agents. It then summarizes research on sugammadex, which appears to be a more effective reversal agent than anticholinesterases, allowing faster recovery from neuromuscular blockade. Sugammadex may allow safer use of muscle relaxants and replace agents like suxamethonium, but economic factors will also influence its adoption.
Lecture to FACE Conference London by Dr. Patrick Treacy about split face study comparing two recent CO2 resurfacing lasers. Lasers compared were the Lumenis ActiveFx and the Deka SmartXide DOT
Dr. Niranjan Kumar Verma¹*, Dr. Mahesh Kumar²
¹Professor, Department of Anaesthesiology, JLN Medical College & Hospital, Bhagalpur, India
²Assistant Professor, Department of Anaesthesiology, JLN Medical College & Hospital, Bhagalpur, India
*Address for Correspondence: Dr. Niranjan Kumar Verma, Professor, Department of Anaesthesiology, JLN Medical
College & Hospital, Bhagalpur, India
Received: 04 Sept 2016/Revised: 28 Sept 2016/Accepted: 18 Oct 2016
ABSTRACT- BACKGROUND & OBJECTIVES: Control of post spinal shivering is essential for optimal
peri-operative care as shivering is a cause of discomfort and dissatisfaction in patients undergoing operations under spinal
anaesthesia. The aim of the study is to assess the efficacy and safety of intravenous Clonidine, Dexmedetomidine and
Tramadol in the treatment of post spinal intra-operative shivering.
MATERIALS AND METHODS: In this prospective, double blind, randomized study, 90 ASA grade I and II patients of
patients aged 18 – 50 rears, scheduled for various routine surgical procedures under spinal anaesthesia with hyperbaric
Bupivacaine and who developed shivering were selected. The patients were divided into three groups of 30 each.
Group- C (n=30) comprised of the patients who received Clonidine 0.5mcg/kg intravenously, Group-D (n=30) who
received Dexmedetomidine 0.5mcg/kg IV and Group T (n=30) receiving Tramadol 2 mg/kg (maximum 100mg) IV. The
efficacy and response rate of the study drugs were evaluated and recorded. Side effects like, nausea, vomiting,
hypotension, bradycardia, sedation and headache, if present, were recorded. All data were analyzed using Chi-square test
and student-t test and expressed in >0.05, (which is insignificant) and < 0.05, (which is significant differences).
RESULTS: There were significant differences in the total response rate between the drugs (p > 0.05), Tramadol showing
the highest response rate (100%). Time taken from the start of treatment to cessation of shivering was significantly less
(p<0.05) in Dexmedetomidine group, but Tramadol group shows complete control of post spinal shivering with none or
lesser and mild degree of side effects with a single dose.
CONCLUSION: Complete control of post spinal intra-operative shivering with less or no severe side effects could be
achieved with Tramadol in comparisons to clonidine and Dexmedetomidine.
Key-words- Post spinal Shivering, Clonidine, Dexmedetomidine, Tramadol
The document summarizes the properties and clinical uses of dexmedetomidine, a highly selective alpha-2 adrenergic receptor agonist. It was first synthesized in the 1980s and approved by the FDA in 1999 for sedation in intensive care units. Dexmedetomidine has sedative, anxiolytic, and analgesic effects. It provides a unique sedation state resembling natural sleep and reduces opioid requirements. Clinical trials demonstrate dexmedetomidine results in shorter ICU and ventilator times compared to midazolam. Adverse effects include hypotension and bradycardia. The document reviews the pharmacokinetics, mechanisms of action, clinical effects, indications and trials of dexmedetomidine
Clinical Experience in Maxillary and Mandibular division block for Trigeminal...iosrphr_editor
The IOSR Journal of Pharmacy (IOSRPHR) is an open access online & offline peer reviewed international journal, which publishes innovative research papers, reviews, mini-reviews, short communications and notes dealing with Pharmaceutical Sciences( Pharmaceutical Technology, Pharmaceutics, Biopharmaceutics, Pharmacokinetics, Pharmaceutical/Medicinal Chemistry, Computational Chemistry and Molecular Drug Design, Pharmacognosy & Phytochemistry, Pharmacology, Pharmaceutical Analysis, Pharmacy Practice, Clinical and Hospital Pharmacy, Cell Biology, Genomics and Proteomics, Pharmacogenomics, Bioinformatics and Biotechnology of Pharmaceutical Interest........more details on Aim & Scope).
General anesthesia & obstetrics part IIISandro Zorzi
→ Discuss indications of general anesthesia for operative delivery
→ Explain aspiration risk for general anesthesia in pregnancy and prevention strategy
Outline anaesthesia plan of care for induction, maintenance and emergency
Describe effect of volatile anaesthetics on uterine blood flow and tone
Discuss intraoperative strategies to prevent postoperative nausea and vomiting
Discuss other complications of general anaesthesia and clinical management
Topical dorzolamide for macular edema in the early phase after vitrectomy and...Avaleks-Kiev
Background: The purpose of this study was to evaluate prospectively the efficacy of a topical carbonic anhydrase inhibitor in macular edema after vitrectomy.
Цель: оценка перспективы использования топического ингибитора карбоангидразы для профилактики развития макулярного отека после витрэктомии.
http://ophthalmolog.kiev.ua/
This document describes a research study protocol to evaluate the efficacy of intrathecal dexmedetomidine as an adjuvant to levobupivacaine spinal anesthesia for abdominal hysterectomy. The study will randomly assign 104 patients to receive either levobupivacaine with normal saline or levobupivacaine with 10 μg dexmedetomidine intrathecally. The primary outcomes will be postoperative analgesia duration measured by VAS scores and time to first rescue analgesic. Secondary outcomes include sensory and motor block durations and any intraoperative hemodynamic changes or side effects. Standard protocols will be followed for preoperative, intraoperative and postoperative care.
This document provides information on neuromuscular blocking drugs (NMBDs) including suxamethonium, non-depolarizing NMBDs, and anticholinesterases. It discusses the pharmacology, indications, side effects and dosing of these drugs. Suxamethonium is a depolarizing NMBD that produces rapid onset of paralysis but has a short duration of action. Non-depolarizing NMBDs like atracurium and rocuronium are competitive antagonists that produce paralysis through blockade of nicotinic receptors. Anticholinesterases are used to reverse the effects of non-depolarizing NMBDs by inhibiting acetylcholinesterase and increasing acetylch
Recent advances in anesthesia and painless surgeries.pptxinfo622939
Embark on a journey into the future of surgical care with our presentation on 'Recent Advances in Anesthesia and Painless Surgeries.' Explore the cutting-edge technologies and methodologies that are reshaping the landscape of anesthesia, transforming surgical experiences into virtually painless procedures.
Formulation, characterization and Evaluation of Transdermal Film Containing N...pharmaindexing
This document summarizes research on developing a transdermal film containing the drug naproxen. Transdermal films were prepared using ethyl cellulose polymer and dibutylpthalate plasticizer via solvent casting. The films were evaluated for physical characteristics, drug content, thickness, moisture uptake, and in vitro drug release. Two formulations with different polymer concentrations (NXN1 and NXN2) showed consistent drug release over 10 hours, with NXN2 containing the higher polymer concentration releasing drug more slowly. The results indicate transdermal films have potential as an alternative delivery method for naproxen to avoid gastrointestinal side effects.
Formulation, characterization and Evaluation of Transdermal Film Containing N...SriramNagarajan15
Transdermal drug delivery system has numerous advantages over the more traditional drug delivery systems. This includes high bioavailability, steady drug plasma concentration, absence of first pass hepatic metabolism effect. Transdermal film is an adhesive film that has a coating of a drug that is placed on the skin to deliver a specific dose of the drug into the bloodstream over a period. The aim of present study an attempt was made to design the transdermal drug delivery system of naproxen with Ethyl Cellulose polymer in various concentrations. Transdermal films were prepared by solvent casting method by using Dibutylpthalate as plasticizer. The prepared films were characterized in physical appearance, thickness, drug content, weightvaration, Folding endurance, percentage moisture uptake and in-vitro release study.
This document discusses neuromuscular blocking agents (NMBAs). It begins by explaining the physiological mechanism of NMBAs and how they interact with nicotinic cholinergic receptors. It then classifies NMBAs as either depolarizing (succinylcholine) or nondepolarizing drugs. Several nondepolarizing NMBAs are discussed in depth, including atracurium, cisatracurium, rocuronium, vecuronium, and pancuronium. The document also covers drug interactions, altered responses to NMBAs, reversal of neuromuscular blockade, and monitoring neuromuscular blockade. Reversal agents like neostigmine, pyridostig
Evaluation of Effect of Low Dose Fentanyl, Dexmedetomidine and Clonidine in S...iosrjce
In the present study effect of intrathecal hyperbaric Bupivacaine 0.5% with low doses of Clonidine
or Fentanyl or Dexmedetomidine were compared in elective lower abdominal surgeries. This was a prospective
randomized control trial. 90 patients belonging to ASA 1 &II, aged between 20-50 years were allocated into
three groups. Group-C: Clonidine 30µg, Group-D: Dexmedetomidine 5 µg, Group-F: Fentanyl 25 µg. The
onset of sensory blockade was comparable in all the three groups. The onset of motor blockade was earlier by
about 1.3 mins in Dexmedetomidine group when compared to Clonidine and Fentanyl group. Duration of
sensory blockade was prolonged in Dexmedetomidine group (346mins) when compared to Clonidine (300mins)
and Fentanyl (302mins) group. Time duration of motor blockade was prolonged in Dexmedetomidine group
(269mins) when compared to Clonidine (223mins) and Fentanyl (220mins) group. The haemodynamic
parameters were clinically and statistically insignificant The time of first request for analgesics by the patients
was more in Dexmedetomidine group (250mins) when compared to Clonidine (194mins) and Fentanyl
(189mins) group. The use of intrathecal Dexmedetomidine as an adjuvant to Bupivacaine is an attractive
alternative to Fentanyl or Clonidine for long duration surgical procedures due to its profound intrathecal
anesthetic and analgesic properties combined with minimal side effects.
This document presents a dissertation proposal comparing the effects of dexmedetomidine and clonidine as adjuvants to isobaric ropivacaine 0.75% in spinal anesthesia for lower limb and lower abdominal surgeries. The study aims to evaluate the onset and duration of sensory and motor blocks, hemodynamic changes, duration of analgesia, and side effects. It will be an observational study of 70 patients randomized into two groups receiving either dexmedetomidine or clonidine with ropivacaine. Outcomes will include time to onset and length of blocks, hemodynamics, analgesia duration, and adverse effects. The researcher hypothesizes that dexmedetomidine will provide faster onset and longer
- Gamma cyclodextrin is a torus-shaped molecule with a hydrophilic exterior and lipophilic interior that can encapsulate guest molecules. Sugammadex is a modified gamma cyclodextrin that can encapsulate the neuromuscular blocking drug rocuronium.
- By adding sugar side chains and ethyl carboxyl groups to gamma cyclodextrin, sugammadex was engineered to have a larger lipophilic cavity able to accommodate the rocuronium molecule and hold it electrostatically.
- Studies show sugammadex rapidly reverses moderate and deep neuromuscular blockade from rocuronium, with recovery times within minutes compared to hours with spontaneous recovery.
This paper investigates the shell properties and concentration stability of a new acoustofluidic delivery agent liposome in comparison to DefinityTM microbubbles. Frequency dependent attenuation measurements were used to estimate the shell stiffness (Sp) and friction (Sf) parameters of both agents. The liposome had lower Sp and Sf values compared to DefinityTM microbubbles. Temperature increase resulted in decreased Sf for both agents but increased Sp for liposomes and decreased Sp for microbubbles. Size distribution measurements using tunable resistive pulse sensing showed the liposomes maintained >80% concentration for 24 hours at physiological temperature, while microbubbles maintained only 27% over the same period.
This document discusses anticholinesterases, which are drugs that inhibit acetylcholinesterase and thereby increase acetylcholine levels at neuromuscular junctions. It describes the mechanisms of both reversible and irreversible anticholinesterases. Reversible anticholinesterases include neostigmine, pyridostigmine, and edrophonium. Irreversible anticholinesterases include organophosphorus compounds. The document also discusses the mechanism of action and effects of the selective relaxant binding agent sugammadex, which is able to rapidly reverse the effects of the neuromuscular blocking drug rocuronium.
This document discusses the management of high grade brain tumors. It begins by stating that gliomas make up 60% of primary brain tumors, with two-thirds being clinically aggressive high-grade tumors. The treatment involves a multimodality approach of surgery, radiation therapy, and chemotherapy. For glioblastomas, all three modalities are typically used at initial diagnosis. The standard treatment for glioblastoma is maximal safe surgical resection followed by radiation therapy with concurrent temozolomide chemotherapy and subsequent adjuvant temozolomide chemotherapy. Radiation techniques, chemotherapy options, targeted therapies, and clinical prognostic factors are also discussed.
IOSR Journal of Pharmacy (IOSRPHR), www.iosrphr.org, call for paper, research...iosrphr_editor
This study investigated the effects of oral clonidine premedication on hemodynamic changes during laparoscopic cholecystectomy. 100 patients were randomly assigned to receive either oral clonidine 150 micrograms or ranitidine 150 mg 90 minutes before surgery. Heart rate, blood pressure, and the need for antihypertensive treatment were significantly lower in the clonidine group during and after surgery. Postoperative nausea, vomiting, shivering, pain, and sedation were also reduced with clonidine premedication. The results suggest that oral clonidine can provide hemodynamic stability and reduce postoperative complications for patients undergoing laparoscopic cholecystectomy.
This document provides an overview of the diagnostic workup and treatment for myasthenia gravis. Key points include:
- Common symptoms include fluctuating weakness that worsens with exertion and improves with rest. Physical exam looks for muscle weakness and fatigability.
- Diagnostic tests include acetylcholine receptor antibodies, repetitive nerve stimulation, and single fiber electromyography to confirm diagnosis.
- Treatment involves anticholinesterase medications to increase acetylcholine levels, immunosuppressants like prednisone and azathioprine to reduce antibody production, and sometimes thymectomy to remove the thymus gland.
MUNODA Final Report by Michael McPeck.pdfmichaelgolub7
1) The document compares the effects of aerosol delivery from a small volume nebulizer under three test configurations: connected to an aerosol mask, "slipped under" a non-rebreathing mask, and connected to the MUNODA device attached to a non-rebreathing mask.
2) Testing was conducted in vitro using a breathing simulator and measuring the inhaled mass, residual mass, and estimated mass balance of radiolabeled saline aerosol under each configuration.
3) Results showed the MUNODA/non-rebreathing mask configuration delivered the highest mean inhaled mass and lowest mean residual mass, representing the most efficient aerosol delivery method according
Ulcerative colitis explanation, management and therapyYuliaDjatiwardani2
A chronic, inflammatory bowel disease that causes inflammation in the digestive tract.
Ulcerative colitis is usually only in the innermost lining of the large intestine (colon) and rectum. Forms range from mild to severe. Having ulcerative colitis puts a patient at increased risk of developing colon cancer.
Symptoms include rectal bleeding, bloody diarrhoea, abdominal cramps and pain.
Treatment includes medication and surgery.
Ulcerative colitis is a lifelong inflammatory disease affecting the rectum and colon to a variable extent. In 2023, the prevalence of ulcerative colitis was estimated to be 5 million cases around the world, and the incidence is increasing worldwide. Ulcerative colitis is thought to occur in people with a genetic predisposition following environmental exposures; gut epithelial barrier defects, the microbiota, and a dysregulated immune response are strongly implicated. Patients usually present with bloody diarrhoea, and the diagnosis is based on a combination of clinical, biological, endoscopic, and histological findings. The aim of medical management is, first, to induce a rapid clinical response and normalise biomarkers and, second, to maintain clinical remission and reach endoscopic normalisation to prevent long-term disability. Treatments for inducing remission include 5-aminosalicylic acid drugs and corticosteroids. Maintenance treatments include 5-aminosalicylic acid drugs, thiopurines, biologics (eg, anti-cytokines and anti-integrins), and small molecules (Janus kinase inhibitors and sphingosine-1-phosphate receptor modulators). Although the therapeutic options are expanding, 10–20% of patients still require proctocolectomy for medically refractory disease. The keys to breaking through this therapeutic ceiling might be the combination of therapeutics with precision and personalised medicine.
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Similar a Sugammadex is a modified gamma-dextro agent
Clinical Experience in Maxillary and Mandibular division block for Trigeminal...iosrphr_editor
The IOSR Journal of Pharmacy (IOSRPHR) is an open access online & offline peer reviewed international journal, which publishes innovative research papers, reviews, mini-reviews, short communications and notes dealing with Pharmaceutical Sciences( Pharmaceutical Technology, Pharmaceutics, Biopharmaceutics, Pharmacokinetics, Pharmaceutical/Medicinal Chemistry, Computational Chemistry and Molecular Drug Design, Pharmacognosy & Phytochemistry, Pharmacology, Pharmaceutical Analysis, Pharmacy Practice, Clinical and Hospital Pharmacy, Cell Biology, Genomics and Proteomics, Pharmacogenomics, Bioinformatics and Biotechnology of Pharmaceutical Interest........more details on Aim & Scope).
General anesthesia & obstetrics part IIISandro Zorzi
→ Discuss indications of general anesthesia for operative delivery
→ Explain aspiration risk for general anesthesia in pregnancy and prevention strategy
Outline anaesthesia plan of care for induction, maintenance and emergency
Describe effect of volatile anaesthetics on uterine blood flow and tone
Discuss intraoperative strategies to prevent postoperative nausea and vomiting
Discuss other complications of general anaesthesia and clinical management
Topical dorzolamide for macular edema in the early phase after vitrectomy and...Avaleks-Kiev
Background: The purpose of this study was to evaluate prospectively the efficacy of a topical carbonic anhydrase inhibitor in macular edema after vitrectomy.
Цель: оценка перспективы использования топического ингибитора карбоангидразы для профилактики развития макулярного отека после витрэктомии.
http://ophthalmolog.kiev.ua/
This document describes a research study protocol to evaluate the efficacy of intrathecal dexmedetomidine as an adjuvant to levobupivacaine spinal anesthesia for abdominal hysterectomy. The study will randomly assign 104 patients to receive either levobupivacaine with normal saline or levobupivacaine with 10 μg dexmedetomidine intrathecally. The primary outcomes will be postoperative analgesia duration measured by VAS scores and time to first rescue analgesic. Secondary outcomes include sensory and motor block durations and any intraoperative hemodynamic changes or side effects. Standard protocols will be followed for preoperative, intraoperative and postoperative care.
This document provides information on neuromuscular blocking drugs (NMBDs) including suxamethonium, non-depolarizing NMBDs, and anticholinesterases. It discusses the pharmacology, indications, side effects and dosing of these drugs. Suxamethonium is a depolarizing NMBD that produces rapid onset of paralysis but has a short duration of action. Non-depolarizing NMBDs like atracurium and rocuronium are competitive antagonists that produce paralysis through blockade of nicotinic receptors. Anticholinesterases are used to reverse the effects of non-depolarizing NMBDs by inhibiting acetylcholinesterase and increasing acetylch
Recent advances in anesthesia and painless surgeries.pptxinfo622939
Embark on a journey into the future of surgical care with our presentation on 'Recent Advances in Anesthesia and Painless Surgeries.' Explore the cutting-edge technologies and methodologies that are reshaping the landscape of anesthesia, transforming surgical experiences into virtually painless procedures.
Formulation, characterization and Evaluation of Transdermal Film Containing N...pharmaindexing
This document summarizes research on developing a transdermal film containing the drug naproxen. Transdermal films were prepared using ethyl cellulose polymer and dibutylpthalate plasticizer via solvent casting. The films were evaluated for physical characteristics, drug content, thickness, moisture uptake, and in vitro drug release. Two formulations with different polymer concentrations (NXN1 and NXN2) showed consistent drug release over 10 hours, with NXN2 containing the higher polymer concentration releasing drug more slowly. The results indicate transdermal films have potential as an alternative delivery method for naproxen to avoid gastrointestinal side effects.
Formulation, characterization and Evaluation of Transdermal Film Containing N...SriramNagarajan15
Transdermal drug delivery system has numerous advantages over the more traditional drug delivery systems. This includes high bioavailability, steady drug plasma concentration, absence of first pass hepatic metabolism effect. Transdermal film is an adhesive film that has a coating of a drug that is placed on the skin to deliver a specific dose of the drug into the bloodstream over a period. The aim of present study an attempt was made to design the transdermal drug delivery system of naproxen with Ethyl Cellulose polymer in various concentrations. Transdermal films were prepared by solvent casting method by using Dibutylpthalate as plasticizer. The prepared films were characterized in physical appearance, thickness, drug content, weightvaration, Folding endurance, percentage moisture uptake and in-vitro release study.
This document discusses neuromuscular blocking agents (NMBAs). It begins by explaining the physiological mechanism of NMBAs and how they interact with nicotinic cholinergic receptors. It then classifies NMBAs as either depolarizing (succinylcholine) or nondepolarizing drugs. Several nondepolarizing NMBAs are discussed in depth, including atracurium, cisatracurium, rocuronium, vecuronium, and pancuronium. The document also covers drug interactions, altered responses to NMBAs, reversal of neuromuscular blockade, and monitoring neuromuscular blockade. Reversal agents like neostigmine, pyridostig
Evaluation of Effect of Low Dose Fentanyl, Dexmedetomidine and Clonidine in S...iosrjce
In the present study effect of intrathecal hyperbaric Bupivacaine 0.5% with low doses of Clonidine
or Fentanyl or Dexmedetomidine were compared in elective lower abdominal surgeries. This was a prospective
randomized control trial. 90 patients belonging to ASA 1 &II, aged between 20-50 years were allocated into
three groups. Group-C: Clonidine 30µg, Group-D: Dexmedetomidine 5 µg, Group-F: Fentanyl 25 µg. The
onset of sensory blockade was comparable in all the three groups. The onset of motor blockade was earlier by
about 1.3 mins in Dexmedetomidine group when compared to Clonidine and Fentanyl group. Duration of
sensory blockade was prolonged in Dexmedetomidine group (346mins) when compared to Clonidine (300mins)
and Fentanyl (302mins) group. Time duration of motor blockade was prolonged in Dexmedetomidine group
(269mins) when compared to Clonidine (223mins) and Fentanyl (220mins) group. The haemodynamic
parameters were clinically and statistically insignificant The time of first request for analgesics by the patients
was more in Dexmedetomidine group (250mins) when compared to Clonidine (194mins) and Fentanyl
(189mins) group. The use of intrathecal Dexmedetomidine as an adjuvant to Bupivacaine is an attractive
alternative to Fentanyl or Clonidine for long duration surgical procedures due to its profound intrathecal
anesthetic and analgesic properties combined with minimal side effects.
This document presents a dissertation proposal comparing the effects of dexmedetomidine and clonidine as adjuvants to isobaric ropivacaine 0.75% in spinal anesthesia for lower limb and lower abdominal surgeries. The study aims to evaluate the onset and duration of sensory and motor blocks, hemodynamic changes, duration of analgesia, and side effects. It will be an observational study of 70 patients randomized into two groups receiving either dexmedetomidine or clonidine with ropivacaine. Outcomes will include time to onset and length of blocks, hemodynamics, analgesia duration, and adverse effects. The researcher hypothesizes that dexmedetomidine will provide faster onset and longer
- Gamma cyclodextrin is a torus-shaped molecule with a hydrophilic exterior and lipophilic interior that can encapsulate guest molecules. Sugammadex is a modified gamma cyclodextrin that can encapsulate the neuromuscular blocking drug rocuronium.
- By adding sugar side chains and ethyl carboxyl groups to gamma cyclodextrin, sugammadex was engineered to have a larger lipophilic cavity able to accommodate the rocuronium molecule and hold it electrostatically.
- Studies show sugammadex rapidly reverses moderate and deep neuromuscular blockade from rocuronium, with recovery times within minutes compared to hours with spontaneous recovery.
This paper investigates the shell properties and concentration stability of a new acoustofluidic delivery agent liposome in comparison to DefinityTM microbubbles. Frequency dependent attenuation measurements were used to estimate the shell stiffness (Sp) and friction (Sf) parameters of both agents. The liposome had lower Sp and Sf values compared to DefinityTM microbubbles. Temperature increase resulted in decreased Sf for both agents but increased Sp for liposomes and decreased Sp for microbubbles. Size distribution measurements using tunable resistive pulse sensing showed the liposomes maintained >80% concentration for 24 hours at physiological temperature, while microbubbles maintained only 27% over the same period.
This document discusses anticholinesterases, which are drugs that inhibit acetylcholinesterase and thereby increase acetylcholine levels at neuromuscular junctions. It describes the mechanisms of both reversible and irreversible anticholinesterases. Reversible anticholinesterases include neostigmine, pyridostigmine, and edrophonium. Irreversible anticholinesterases include organophosphorus compounds. The document also discusses the mechanism of action and effects of the selective relaxant binding agent sugammadex, which is able to rapidly reverse the effects of the neuromuscular blocking drug rocuronium.
This document discusses the management of high grade brain tumors. It begins by stating that gliomas make up 60% of primary brain tumors, with two-thirds being clinically aggressive high-grade tumors. The treatment involves a multimodality approach of surgery, radiation therapy, and chemotherapy. For glioblastomas, all three modalities are typically used at initial diagnosis. The standard treatment for glioblastoma is maximal safe surgical resection followed by radiation therapy with concurrent temozolomide chemotherapy and subsequent adjuvant temozolomide chemotherapy. Radiation techniques, chemotherapy options, targeted therapies, and clinical prognostic factors are also discussed.
IOSR Journal of Pharmacy (IOSRPHR), www.iosrphr.org, call for paper, research...iosrphr_editor
This study investigated the effects of oral clonidine premedication on hemodynamic changes during laparoscopic cholecystectomy. 100 patients were randomly assigned to receive either oral clonidine 150 micrograms or ranitidine 150 mg 90 minutes before surgery. Heart rate, blood pressure, and the need for antihypertensive treatment were significantly lower in the clonidine group during and after surgery. Postoperative nausea, vomiting, shivering, pain, and sedation were also reduced with clonidine premedication. The results suggest that oral clonidine can provide hemodynamic stability and reduce postoperative complications for patients undergoing laparoscopic cholecystectomy.
This document provides an overview of the diagnostic workup and treatment for myasthenia gravis. Key points include:
- Common symptoms include fluctuating weakness that worsens with exertion and improves with rest. Physical exam looks for muscle weakness and fatigability.
- Diagnostic tests include acetylcholine receptor antibodies, repetitive nerve stimulation, and single fiber electromyography to confirm diagnosis.
- Treatment involves anticholinesterase medications to increase acetylcholine levels, immunosuppressants like prednisone and azathioprine to reduce antibody production, and sometimes thymectomy to remove the thymus gland.
MUNODA Final Report by Michael McPeck.pdfmichaelgolub7
1) The document compares the effects of aerosol delivery from a small volume nebulizer under three test configurations: connected to an aerosol mask, "slipped under" a non-rebreathing mask, and connected to the MUNODA device attached to a non-rebreathing mask.
2) Testing was conducted in vitro using a breathing simulator and measuring the inhaled mass, residual mass, and estimated mass balance of radiolabeled saline aerosol under each configuration.
3) Results showed the MUNODA/non-rebreathing mask configuration delivered the highest mean inhaled mass and lowest mean residual mass, representing the most efficient aerosol delivery method according
Similar a Sugammadex is a modified gamma-dextro agent (20)
Ulcerative colitis explanation, management and therapyYuliaDjatiwardani2
A chronic, inflammatory bowel disease that causes inflammation in the digestive tract.
Ulcerative colitis is usually only in the innermost lining of the large intestine (colon) and rectum. Forms range from mild to severe. Having ulcerative colitis puts a patient at increased risk of developing colon cancer.
Symptoms include rectal bleeding, bloody diarrhoea, abdominal cramps and pain.
Treatment includes medication and surgery.
Ulcerative colitis is a lifelong inflammatory disease affecting the rectum and colon to a variable extent. In 2023, the prevalence of ulcerative colitis was estimated to be 5 million cases around the world, and the incidence is increasing worldwide. Ulcerative colitis is thought to occur in people with a genetic predisposition following environmental exposures; gut epithelial barrier defects, the microbiota, and a dysregulated immune response are strongly implicated. Patients usually present with bloody diarrhoea, and the diagnosis is based on a combination of clinical, biological, endoscopic, and histological findings. The aim of medical management is, first, to induce a rapid clinical response and normalise biomarkers and, second, to maintain clinical remission and reach endoscopic normalisation to prevent long-term disability. Treatments for inducing remission include 5-aminosalicylic acid drugs and corticosteroids. Maintenance treatments include 5-aminosalicylic acid drugs, thiopurines, biologics (eg, anti-cytokines and anti-integrins), and small molecules (Janus kinase inhibitors and sphingosine-1-phosphate receptor modulators). Although the therapeutic options are expanding, 10–20% of patients still require proctocolectomy for medically refractory disease. The keys to breaking through this therapeutic ceiling might be the combination of therapeutics with precision and personalised medicine.
Overactive bladder happens mostly in women but may occur in men. Ageing, an enlarged prostate and diabetes are all risk factors.
The urge to urinate may be difficult to control and lead to the involuntary loss of urine (incontinence). It may be embarrassing or limit activity.
Treatments such as pelvic floor muscle exercises, medication and nerve stimulation can reduce or eliminate symptoms.
Dapagliflozin mechanism of action in weight loss effectYuliaDjatiwardani2
Dapagliflozin, sold under the brand names Farxiga and Forxiga among others, is a medication used to treat type 2 diabetes. It is also used to treat adults with heart failure and chronic kidney disease. it also can induce weight loss
Berikut ini adalah tindakan pertolongan pertama yang sebaiknya Anda lakukan dalam perawatan luka:
Mencuci tangan. Sebelum mulai membersihkan luka, cuci tangan dengan sabun dan air mengalir. ...
Tekan sisa bagian kulit yang berdarah. ...
Bersihkan luka dengan air. ...
Oleskan petroleum jelly atau salep antibiotic. ...
Tutupi dengan perban.
Bevacizumab is a type of targeted cancer drug treatment. It is also known as Avastin. It is a treatment for a number of different cancer types. You pronounce bevacizumab as bev-a-ciz-oo-mab. Depending on your cancer type, you might have bevacizumab in combination with another drug.
Management of Fungal Infection with Voriconazole Ppt.pptxYuliaDjatiwardani2
Antifungal Therapy.
Voriconazole is used to treat serious fungal or yeast infections, such as aspergillosis (fungal infection in the lungs), candidemia (fungal infection in the blood), esophageal candidiasis (candida esophagitis), or other fungal infections (infections in the skin, stomach, kidney, bladder, or wounds).
A cancer that begins in the lungs and most often occurs in people who smoke.
Two major types of lung cancer are non-small cell lung cancer and small cell lung cancer. Causes of lung cancer include smoking, second-hand smoke, exposure to certain toxins and family history.
Symptoms include a cough (often with blood), chest pain, wheezing and weight loss. These symptoms often don't appear until the cancer is advanced.
Treatments vary but may include surgery, chemotherapy, radiation therapy, targeted drug therapy and immunotherapy.
Clinical trials are medical research studies conducted on human subjects. The human subjects are assigned to one or more interventions, and the investigators evaluate the effects of those interventions. The progress and results of clinical trials are analyzed statistically. The aim of statistical analysis in a randomized clinical trial is the comparison of the benefit of treatment compared to control or other groups. This enables medical researchers to analyze the entirety of primary and secondary-use patient data records for unparalleled epidemiological and clinical data. One of the main components of the analysis is the statistical analysis plan (SAP). This plan ensures that the analyses to evaluate all planned study hypotheses. So this explanation in presentation talk about : How to do clinical trials.
The document provides guidance on assessing and managing acute agitation. It defines agitation and related terms. Common causes of agitation include medical conditions, substance use, and primary psychiatric disorders like schizophrenia, bipolar disorder, and dementia. A case example is presented of a man with possible substance withdrawal, delirium, or exacerbation of bipolar disorder. Laboratory results are reviewed. Non-pharmacological and pharmacological approaches are described for reducing agitation in medical settings.
These lecture slides, by Dr Sidra Arshad, offer a simplified look into the mechanisms involved in the regulation of respiration:
Learning objectives:
1. Describe the organisation of respiratory center
2. Describe the nervous control of inspiration and respiratory rhythm
3. Describe the functions of the dorsal and respiratory groups of neurons
4. Describe the influences of the Pneumotaxic and Apneustic centers
5. Explain the role of Hering-Breur inflation reflex in regulation of inspiration
6. Explain the role of central chemoreceptors in regulation of respiration
7. Explain the role of peripheral chemoreceptors in regulation of respiration
8. Explain the regulation of respiration during exercise
9. Integrate the respiratory regulatory mechanisms
10. Describe the Cheyne-Stokes breathing
Study Resources:
1. Chapter 42, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 36, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 13, Human Physiology by Lauralee Sherwood, 9th edition
Cell Therapy Expansion and Challenges in Autoimmune DiseaseHealth Advances
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
Hiranandani Hospital in Powai, Mumbai, is a premier healthcare institution that has been serving the community with exceptional medical care since its establishment. As a part of the renowned Hiranandani Group, the hospital is committed to delivering world-class healthcare services across a wide range of specialties, including kidney transplantation. With its state-of-the-art facilities, advanced medical technology, and a team of highly skilled healthcare professionals, Hiranandani Hospital has earned a reputation as a trusted name in the healthcare industry. The hospital's patient-centric approach, coupled with its focus on innovation and excellence, ensures that patients receive the highest standard of care in a compassionate and supportive environment.
Travel vaccination in Manchester offers comprehensive immunization services for individuals planning international trips. Expert healthcare providers administer vaccines tailored to your destination, ensuring you stay protected against various diseases. Conveniently located clinics and flexible appointment options make it easy to get the necessary shots before your journey. Stay healthy and travel with confidence by getting vaccinated in Manchester. Visit us: www.nxhealthcare.co.uk
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
Our backs are like superheroes, holding us up and helping us move around. But sometimes, even superheroes can get hurt. That’s where slip discs come in.
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Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
Integrating Ayurveda into Parkinson’s Management: A Holistic ApproachAyurveda ForAll
Explore the benefits of combining Ayurveda with conventional Parkinson's treatments. Learn how a holistic approach can manage symptoms, enhance well-being, and balance body energies. Discover the steps to safely integrate Ayurvedic practices into your Parkinson’s care plan, including expert guidance on diet, herbal remedies, and lifestyle modifications.
2. NMBA /
Muscle
Relaxant
in anesthesia to facilitate endotracheal
intubation, assist with mechanical ventilation in
patients who have reduced lung compliance, and
treatment of Convulsion / seizure, and optimize
certain surgical conditions,
https://www.ncbi.nlm.nih.gov/books/NBK538301/
6. Sugammadex Reversal NMBA
Enkapsulasi
Prinsip Kerja Sugammadex membuat kompleks yang dapat larut dalam
air dengan Agen Neuromuscular Blocking (rocuronium > vecuronium) dengan rasio 1:1
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4173552/
1. saat memasuki plasma itu : Sugammadex membungkus
(enkapsulasi) aminosteroid yang bersirkulasi menjadi
tidak aktif
2. Sugammadex mendorong disosiasi (pelepasan) aminosteroid dari
neuromuscular junction (NMJ) lalu dienkapsulasi memungkinkan kembalinya
fungsi neuromuskuler.
7.
8.
9.
10.
11. Postoperative nausea and vomiting (PONV) is not usually a fatal post operative complication but is
nonetheless particularly distressing
One of the most unpleasant experiences during the postoperative period, and has significant consequences
for satisfaction, patient outcomes and costs of care
14. Sugammadex mampu membuat pengosongan ruang operasi
lebih cepat dan dapat diprediksi
aOR discharge times:
neostigmine = 13.87 ±
11.43 minutes;
sugammadex = 9.15 ±
4.28 minutes.1
CI = confidence
interval; MD = mean
difference; NMB =
neuromuscular
block; OR =
operating room;
PACU = post-
anesthesia care unit.
P=0.005
Reduction
with
sugammadex:
4.72 minutes
Suatu meta-analisis dari 6 studi yang membandingkan pasien usai diberikan sugammadex dan neostigmin.
Sugammadex diasosiasikan dengan keluarnya pasien dari ruang operasi lebih cepat dari:
– Ruang Operasike post-anesthesiacareunit (PACU) (MD = 22.14 menit, 95% CI [14.62, 29.67], P< 0.00001)
– PACU ke rawat inap (MD = 16.95 menit, 95% CI [0.23, 33.67], P=0.0469)
13.87
9.15
2
0
4
8
6
10
14
12
Waktu rata2 pengosongan OR dengan neostigmine
dan sugammadex4
16
Time
(minutes)
Discharge times
Neostigmine Sugammadex
Reduksi
dengan
sugammadex:
4.72 menit
• Suatu studi acak, terkontrol di Belgia yang melibatkan 100
perempuan yang menjalani laparoskopi histerektomi dari
February 2011 hingga May 2012, ditemukan bahwa
sugammadex mengurangi waktu pengosongan OR sebanyak
rata2 4.72 menit dibandingkan neostigmine (P-0.005).
• Studi ini menunjukan bahwa pengosongan ruang operasi
menjadi lebih singkat dengan variable yang sedikit setelah
pemberian sugammadex dibandingkan neostigmine.
Pengosongan ruang operasi yang lebih singkat juga diamati
dengan membandingkan pasien sugammadex pada NMB level
deep block terhadap pasien neostigmine di level NMB moderate
atau pada level yang lebih rendah
P=0.005
Putz L et al. J Clin Anesth. 2016;35:107– 113
15. Sugammadex dapat meningkatkan jumlah pelaksanaan
operasi serta menurunkan biaya
OR = operating room.
• Waktu yang dihemat dengan sugammadex bukan hanya berdampak pada produktivitas
tapi juga mengurangi biaya yang diasosiasikan dengan OR occupancy.
• Suatu studi restrospektif menganalisa data dari tahun 2009 hingga 2013 pada 99 pasien obesitas yang melalui operasi elektif
bariatric laparoskopi pada suatu institusi di Italia. Pasien mendapatkan rocuronium dilanjutkan dengan Sugammadex (n=50) atau
rocuronium/cisatracurium dilanjutkan dengan neostigmine (n=49). Studi mendapatkan bahwa sugammadex mengurangi durasi
penuhnya ruang operasi (OR occupancy) sehingga dapat mengurangi biaya dan meningkatkan alur kerja
Penambahan operasi dapat dilakukan pada penggunaan sugammadex
dibandingkan neostigmin pada tindakan laparoscopicsleevegastrectomies
Pada waktu yang
samadimana selesai
dilakukannya 50
prosedur bariatric
dengan neostigmine,
12operasi tambahan
dapat dilakukan
dengan waktu yang
lebih hemat dengan
sugammadex.6
Carron M et al.J Clin Anesth. 2017;39:38–44
Sugammadex
16. Model Discrete event simulation (DES) menunjukan bahwa sugammadex dapat mengurangi kelebihan
waktu kerja dari staff di ruang operasi dan meningkatkan efisiensi ruang operasi (OR)
aFull recovery defined
as train-of-four (TOF)
ratio of ≥0.9.
DES = discrete event
simulation; NMB =
neuromuscular block;
OR = operating
room; TOF = train-
of-four.
Satu analisis eksplorasi dari model ini juga menemukan bahwa, saat melakukan reversal
deep NMB, sugammadex dapat menghemat 30 menit waktu di ruang operasi per prosedur
pe bulan dibandingkan dengan neostigmine/glycopyrrolate, yang dapat menghasilkan:
– 62 % reduksi waktu lembur dari staff yang dibayarkan
– Jumlah prosedur yang dibatalkan akibat waktu di ruang operasi yang tidak cukup berkurang dari
1.2 menjadi 0.4
Suatu model discrete event simulation membandingkan ruang operasi yang menggunakan sugammadex sebagai
reversal neuromuscular block (NMB) dengan ruang operasi yang menggunakan neostigmine selama periode 1bulan di suatu rumah sakit di Kanada
Model ini menilai dampak dari sugammadex pada efisiensi ruang operasi tergantung pada persentase pasien sugammadex
yang sepenuhnya pulih dari deep NMB.
– Untuk pasien yang leve deep blocknya dipertahankan hingga akhir prosedur, sugammadex terlihat memperbaiki efisiensi ruang operasi
dan juga mengurangi komplikasi residual blokade.
Perbandingan antara sugammadex dan neostigmine pada efisiensi ruang operasi selama satu bulan pada reversal moderate NMB
Neostigmine
sugammadex
50% of Patients
verified to have full
NMB recovery
sugammadex
100% of Patients
verified to have full
NMB recovery
Persentase hari dimana semua prosedur
diselesaikan pada hitungan hari OR normal
40.6% 58.0% 72.7%
Prosedur yang dibatalkan karena kurangnya
waktu di ruang operasi
3.5 1.9 1.1
Waktu lembur staff yang dibayarkan 57.8 38.9 24.3
InsingaRP et al. BMC Anesthesiol. 2016:1– 12.
17. Sugammadex mengurangi jumlah komplikasi klinis serta biaya
yang menyertai
AE = adverse event.
Cost of complicationswith sugammadex, neostigmine,
and spontaneous recovery strategies
• Komplikasi operasi secara signifikan memberikan dampak
pada pengeluaran rumah sakit dan meningkatkan biaya
operasi sebesar $17,804.
• Sugammadex menunjukan penurunan 70% biaya yang
diasosiasikan dengan komplikasi, dibandingkan dengan
neostigmine.
– Suatu analisis di cost-effectiveness di tahun 2010
dilakukan dengan menggunakan model decision tree
yang mempertimbangkan biaya terapi dan komplikasi
termasuk hipoksia ringan, hipoksia berat dan
pneumonia.
– Frekuensi residual block dan efek samping
diperhitungkan lewat study meta analisis sebelumnya.
Suatu analisis univariate sensitivitas dilakukan untuk
mengecek kekuatan dari model ini.
Bahkan ketika biaya pengobatan diperhitungkan, biaya total grup dengan
sugammadex tetap lebih rendah dari biaya total grup dengan neostigmine dan grup
dengan pemulihan spontan.
Sugammadex
Ozdemir Oet al.International Societyfor Pharmacoeconomics andOutcomesResearch(ISPOR)Annual European Congress.November 6–9, 2010. Poster PND22.
Fu SJet al. Minim InvasiveSurg. 2016;2016:1– 7
18. KEY POINTS
Sugammadex is the first reversal agent to encapsulate aminosteroid
neuromuscular blocking agents, reversing all depths of rocuronium and
vecuronium neuromuscular blockade.
Sugammadex is used in high risk patients surgery as Reversal agent of
Neuromuscular Blocking Agent (NMBA)
Sugammadex is more effective at reversing deep paralysis than neostigmine
Sugammadex is recommended to reduce POPC (Post-operative Pulmonary
Complication) and PONV (Post-operative Nausea Vomiting)
Sugammadex can contribute to the hospital management system in terms of
anesthesiology, surgery, and operating room health care system
https://resources.wfsahq.org/atotw/an-overview-of-sugammadex/
19. FDA dosing recommendations
for adults and children
https://www.openanesthesia.org/keywords/reversal-of-neuromuscular-blockade-sugammadex/
20. SOGOMA(Sugammadex) is a modified gamma cyclodextrin which is a Selective Relaxant Binding Agent
Indications. Reversal of neuromuscular blockade induced by rocuronium or vecuronium
Dosage and Administration. Sugammadex should only be administered by, or under the supervision of an anesthetist. The use of an appropriate neuromuscular
monitoring technique is recommended to monitor the recovery of neuromuscular blockade. The recommended dose of sugammadex depends on the level of
neuromuscular blockade to be reversed.
Deep Block: 4 mg/kg body weight; Moderate Block: 2 mg/kg body weight. Immediate reversal: 16mg/kg sugammadex.
Drug Interactions. Interactions potentially affecting the efficacy of sugammadex: Toremifene, Intravenous administration of fusidic acid. Interactions potentially
affecting the efficacy of other medicinal products: Hormonal contraceptives, The interaction between 4 mg/kg sugammadex and a progestogen was predicted to
lead to a decrease in progestogen exposure
Information on Use in Specific Populations. Renal Impairment: The use of sugammadex in patients with severe renal impairment (including patients requiring
dialysis (CrCl < 30 ml/min)) is not recommended. Elderly patients:Even though the recovery times in elderly tend to be slower, the same dose recommendation as
for adults should be followed. Obese patients: In obese patients, the dose of sugammadex should be based on actual body weight. The same dose
recommendations as for adults should be followed. Hepatic impairment: For mild to moderate hepatic impairment: as sugammadex is mainly excreted renally no
dose adjustments are required. Children and adolescents:For routine reversal of rocuronium induced blockade at reappearance of T2 in children and adolescents
(2-17 years) 2 mg/kg sugammadex is recommended. Term newborn infants and infants:There is only limited experience with the use of sugammadex in infants
(30 days to 2 years), and term newborn infants (less than 30 days) have not been studied. The use of sugammadex in term newborn infants and infants is therefore
not recommended until further data become available.
Adverse Events. Airway Complication of Anesthesia: bucking against the endotracheal tube, coughing, mild bucking, arousal reaction during surgery, coughing
during the anesthetic procedure or during surgery, or contra breath. Anesthetic complication: movement of a limb or the body or coughing during the anesthetic
procedure or during surgery, grimacing, or suckling on the endotracheal tube. Procedural Complication: coughing, tachycardia, bradycardia, movement, and increase in
heart rate. Recurrence of neuromuscular blockade : sub optimal dose.
Drug hypersensitivity reactions: Symptoms associated with these reactions can include: flushing, urticaria erythematous rash, (severe) hypotension, tachycardia,
swelling of tongue, swelling of pharynx, bronchospasm and pulmonary obstructive events. Severe hypersensitivity reactions can be fatal.
Precautions. Re-administration of rocuronium or vecuronium after routine reversal (up to 4 mg/kg Sugammadex):Minimum waiting time 5 min, NMBA and dose to be
Administered 1.2 mg/kg rocuronium, ):Minimum waiting time 4 hours, NMBA and dose to be Administered 0.6 mg/kg rocuronium or 0.1 mg/kg vecuronium.
Marked bradycardia: In rare instances, marked bradycardia has been observed within minutes after the administration of Sugammadex for reversal of neuromuscular
blockade. Patients with bronchospasm: Patient with severe systemic disease (ASA 3 and 4)
SOGOMA Product Information BPOM Approved. 2023
21. First Mitu Product
Sebagai agen reversal dari neuromuscular blockade yang diinduksi oleh
rocuronium atau vecuronium
23. Building a healthier
future for all
At Hetero, we are on an exciting
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Footprints in Indonesia
24. FOLLOW US ON
dr Yulia Djatiwardani | Medical & Pharmacovigilance PT. Amarox Pharma Global (HETERO)
+6287859973339| yulia.ardani@hetero.com
Notas del editor
Ass.wr.wb. Selamat siang salam sejahtera bagi kita semua
Perkenalkan, Saya Lia (dari Medical PT. Amarox – yg merupakan subsidiary Hetero company)
Izinkan saya menyampaikan sekilas mengenai produk kami yang sedang launching :
YAITU SUGAMMADEX. Yang merupakan Reversal dari Neuromuscular blocking agent
Seperti yang diketahui, NMBA / muscle relaxant merupakan obat yang rutin digunakan dalam general anesthesia. Baik pada saat pemasangan intubasi, asis ventilasi mekanik, dan pemberiannya pada operasi-operasi yang memerlukan durasi tertentu.
Hmm ini kami ambil dari guideline for monitoring NMBA American Society of Anesthesiologist 2023…
Tertera pula ditulis bahwa penggunaan NMBA yang rutin sekarang-sekarang ini yang dipakai adalah : Rokuronium & Vekuronium,
Juga ada variasi setiap center berbeda2 pula yaa ada yg menggunakan pankuronium, cisatrakurium, dan juga atrakurium masih dipakai..
Dan berikut untuk klasifikasi Neuromuscular blocking agent..
Ada yang depolarizing dan non depolarizing.
Tentunya dokter wisnu, dan Para rekan anestesi di sini lebih paham yaa….
Untuk penggunaan NMBA yang rutin dipakai pun adalah golongan aminosteroid yaa Dok… beberapa survey dan informasi berbagai RS regimen NMBA nya yg paling rutin adalah Vecuronium dan Rocuronium…
Dan tentunya ketika penggunaan NMBA tersebut dalam batas2 tertentu dengan skore TOF deep block yang dalam, seringkali dibutuhkanlah agen REVERSAL nya artinya diperlukan obat untuk mengembalikan kelumpuhan otot dari efek pemberian NMBA itu sendiri…
Nah disinilah peranan Sugammadex sebagai reversal secara spesifik untuk NMBA Vecuronium dan rocuronium
Sugammadex terdiri dari kata
Sugar : artinya gula
Dan Gammadex : yg merupakan Gamma cyclodextrin
Yang membentuk kompleks dengan Neuromuscular Blocking Agent (NMBA) Rocuronium atau Vecuronium dalam plasma dan dengan demikian mengurangi jumlah NMBA yang dan menghasilkan efek reversal.
Ini mekanisme of action Sugammadex :
Yang mana Prinsip Kerja Sugammadex membuat kompleks yang dapat larut dalam air dengan Agen NMBA (rocuronium > vecuronium) dengan rasio 1 : 1
Saat memasuki plasma itu : Sugammadex membungkus // atau istilahnya (enkapsulasi) aminosteroid yang bersirkulasi dan membuatnya menjadi tidak aktif
Hal ini mendorong disosiasi (pelepasan) aminosteroid dari neuromuscular junction (NMJ) yg dienkapsulasi sehingga memungkinkan kembalinya fungsi neuromuskular.
Ini juga practice guidelines dari ASA 2023,
Disini dikatakan pemberian Sugammadex direkomendasikan untuk merevert efek NMBA baik blocking yang deep, moderate, bahkan yang shallow level neuromuscular blockade.
Utk range TOF nya 0,4 atau kurang dari 0,9.
Rekomendasi pemberian sugammadex sendiri masuknya kategori strongly recommended yaa dengan level evidence nya yang moderate…
Sugammadex lebih unggul dibandingkan neostigmine yg hanya direkomendasikan secara kondisional dan low evidence based.
Ini menurut journal of clinical medicine MDPI tahun 2020 :
Dikatakan pada artikel ini : pemberian reversal dengan Sugammadex Bersama dengan ventilasi low tidal volum dapat menurunkan angka mortalitas postoperative pulmonary complication pada kelompok beresiko tinggi yang menjalani operasi abdomen.
Sementara Diketahui pada pengamatan 90 hari resiko mortalitas dapat signifikan meningkat pada kelompok yang mengalami postoperative pulmonary complication (atau PPC).
Jadi tentunya Sugammadex disini memiliki peranan yg baik dalam mengurangi risiko PPC dan tentunya mengurangi angka mortalitas itu sendiri
Sementara berikut study : Sugammadex VS Neostigmin tahun 2020. ini stronger study Namanya :
Dengan outcome yg diamati bahwa pemberian sugammadex dikaitkan dengan :
Pengurangan 30% risiko komplikasi paru
Pengurangan 47% resiko peneumonia
Dan 55% mengurangi risiko respiratory failure
Lebih signifikan dibandingkan neostigmin
Dan sebuah metaanalysis dengan Cochrane database system review tahun 2017 :
Menyimpulkan bahwa sugammadex sebagai agen reversal NMBA dapat menurunkan insiden gejala residual NMBA dengan berbagai tingkatan residual yang secara efikasi lebih efektif, lebih cepat dibanding neostigmine,,
Dan sugammadex juga dikaitkan dengan safety profile yang lebih tolerable dan baik disbanding neostigmine.
Lalu untuk kejadian Postoperative nausea and vomiting (PONV) yang mana PONVY ini juga menjadi Salah satu gejala yang tidak menyenangkan selama periode pasca operasi, dan memiliki konsekuensi yang signifikan terhadap outcome kepuasan pasien, dan juga biaya perawatan rumah sakit….
Beberapa risiko kejadian PONVY yaitu pada pasien Wanita,, dengan risiko pembedahan,, penggunaan volatile anesthesia,, ada Riwayat PONVY sebelumnya atau Riwayat motion sickness,, pada pasien yang tidak merokok,, dengan durasi pembedahan tertentu pada kelompok usia tertentu,, dan juga penggunaan opioid ini bisa meningkatkan hingga 49% kejadian PONVY
Dan sebagai tatalaksana PONVY ini ada guideline dari : consensus ke-4 Management Postoperative nausea and vomiting Anesth analg 2020
Ini adalah berbagai Langkah-Langkah yang direkomendasikan dalam penanganan PONVY :
Yang mana salah satu poin rekomendasinya menyebutkan : bahwa penggunaan SUGAMMADEX perlu diberikan sebagai reversal NMBA dengan level rekomendasinya A1 (artinya strongly recommended yaa) dan sugammadex pun lebih dipilih dibandingkan neostigmin
Systematical review dan metaanalysis dari 6 study juga menyebutkan : bahwa
risiko PONVY dapat berkurang secara signifikan pada pemberian Sugammadex dibandingkan neostigmin
Suatu meta-analisis dari 6 studi yang membandingkan pasien usai diberikan sugammadex dan neostigmine menunjukkan Sugammadex diasosiasikan dengan keluarnya pasien dari ruang operasi lebih cepat
– dari Ruang Operasi ke post-anesthesia care unit (PACU) (MD = 22.14 menit, 95% CI [14.62, 29.67], P< 0.00001)
– PACU ke rawat inap (MD = 16.95 menit, 95% CI [0.23, 33.67], P=0.0469)
Waktu yang dihemat dengan sugammadex bukan hanya berdampak pada produktivitas api juga mengurangi biaya yang diasosiasikan dengan OR occupancy.
Jadi Sugammadex juga dapat meningkatkan jumlah pelaksanaan operasi serta cost effective disbanding neostigmin
Satu analisis eksplorasi juga menemukan bahwa, saat melakukan reversal deep NMBlokade sugammadex dapat menghemat 30 menit waktu di ruang operasi/ per prosedur/ per bulan dibandingkan dengan neostigmine/glycopyrrolate, yang dapat menghasilkan:
62 % reduksi waktu lembur dari staff yang dibayarkan
Jumlah prosedur yang dibatalkan akibat waktu di ruang operasi yang tidak cukup
Bahkan pada study pharmacoeconomy outcome research annual European congress menunjukkan :
ketika biaya pengobatan diperhitungkan, biaya total grup dengan sugammadex tetap lebih rendah dari biaya total grup dengan neostigmine dan grup dengan pemulihan spontan (yg memiliki risiko tinggi)
Jadi kalau boleh kami sampaikan kesimpulan sebagai takehome message:
Sugammadex adalah reversal agent dengan mekanisme kerjanya yang meng enkapsulasi mengembalikan efek NMBA aminosteroid : Rokuronium & Vecuronium
Sugammadex digunakan pada operasi- operasi pasien berisiko tinggi
Sugammadex lebih efektif dalam mereversal deep blockade dibandingkan neostigmine
Sugammadex direkomendasikan dalam pencegahan dan pengurangan angka kejadian POPC (Komplikasi Paru Pasca Operasi) dan PONV (Mual Muntah Pasca Operasi)
Dan Sugammadex juga dapat berkontribusi pada sistem manajemen rumah sakit dalam hal manajemen di anestesiologi, sistem manajemen system perawatan di OK. ruang operasi
Berikut dosis pemberian sugammadex sebagai REVERSAL agent :
Ini menurut FDA bila pada pasien anak:
Tentunya mempertimbangkan TOF & PTC score nya..
Dosis yang direkomendasikan : 2mg/kgBB, 4mg/kbBB,- hingga 16mg/kgBB tergantung dari tingkatan kedalaman blokadenya yang ingin direvert.
Dan berikut produk Informasi kami sesuai approval oleh badan POM 2023.
Sugammadex kami brand nya SOGOMA.
Dengan Indikasi sebagai Reversal NMBA rocuronium dan vecuronium.
Dan dosisnya :
Utk reverse Deep Block : 4 mg/kg body weight;
Utk reverse Moderate Block: 2 mg/kg body weight
Sedangkan utk Immediate reversal: adalah 16 mg/kg
Yak ini yaa Produk sugammadex kami:
Namanya SOGOMA.
Jadi SOGOMA ini merupakan first copy product dari sugammadex originator nya….
Nomor izin Edar dari BPOM terbit sejak Januari 2023… dan launching ini sudah ready di tangan teman-teman sales kami di Surabaya ada Bu Irna dan bu Leony.
Dan perlu kami soundingkan juga bahwa SOGOMA tayang di E-Katalog… berikut yaa ada link nya juga terlampir..
Sogoma berisi 100mg/ mL
Ini per vialnya ada 2 mL jadi 1 kemasan SOGOMA mengandung 200mg Sugammadex
Demikian Overview terkait produk hospicare HETERO.
Terakhir, dari kami:
Hetero berkomitmen akan selalu menyediakan akses yang affordable untuk pengobatan dan terapi yang bermanfaat bagi para pasien dokter.
Kami juga terus mendukung berbagai kegiatan serta pengembangan scientific untuk menciptakan dunia Kesehatan yang lebih baik lagi.
Akhir kata,,, saya ucapkan terimakasih banyak kepada
dr.Wisnu Baroto Sp.An
Dr. ..
Dan tim Anestesi di RS RKZ Surabaya
Serta bapak ibu : Doktor, dokter, dan para klinisi yang telah berpartisipasi dalam kegiatan ini
Semoga setelah ini dapat menjadi diskusi berkelanjutan….. Ada case sharing juga yaa dari dokter WISNU BAROTO… Monggo DOK…
Dan semoga kedepannya Hetero bisa terus berkolaborasi dg baik Bersama Anestesi RS RKZ Surabaya
Demikian yg dapat kami sampaikan. Terimakasih atas waktu dan perhatiannya.
Ass.wr.wb. Acara kami kembalikan ke Moderator…