This paper presents an echo of what transpired during the meeting written in a question ans answer format.
MUSCLE RELAXANTS, CENTRAL ; NEUROMUSCULAR BLOCKADE ; NEUROMUSCULAR AGENTS

BACKGROUND: Cisatracurium , an R-cis, R-cis isomer of atracurium, is a benzoquinolinium non-depolarizing muscle relaxant with intermediate duration of action that has the advantage of minimal histamine release compared to the parent compound atracurium. Similar studies have described cisatracurium to have cardiovascular stability up to 7 times the ED95 dose. However, few have been conclusive owing to concomitant use of agents that can cause potential histamine release and hemodynamic effects. This study was specifically designed to minimize these variables. The promise of the clinical advantages of the use of cisatracurium merits investigation against its parent compound atracurium in the Filipino population especially in terms of hemodynamic stability when utilized intraoperatively. The study was conducted to evaluate the onset of action, conditions for intubation, duration of neuromuscular block and side effects of cisatracurium compared to atracurium among Filipino surgical patients METHODOLOGY: A prospective, randomized, double-blind study was performed in eighty one (81) healthy patients of ASA Physical Status 1 and 2 undergoing elective surgical procedures treated with either 0.15 mg/kg cisatracurium (3 x ED 95) n=39 or 0.5 mg/kg atracurium (3 x ED 95) n=42 administered over 5 seconds intravenous bolus under adequate anesthesia, before surgical stimulation. We compared the time course of the neuromuscular block and determined whether the muscle relaxants caused cutaneous and systemic evidence of histamine release. Induction of general anesthesia commenced with the use of propofol-fentanyl in oxygen. Stabilization of the Neuromuscular junction was achieved prior to the administration of the muscle relaxants with the use of tetanic stimulation of 50 Hz; for 5 seconds followed by single twitch stimuli for 2 minutes. Neuromuscular transmission was assessed by recording the mechanical twitch response to train-of-four nerve stimulations every 10 seconds. Cutaneous manifestations, blood pressures and heart rates were recorded periodically. RESULTS: Time to 95 percent block were 77.09-155.99 seconds with cisatracurium. and 64.60 - 128.21 seconds with atracurium. The administration of either muscle relaxant resulted in complete neuromuscular block in all patients providing good to excellent intubating conditions. The time to spontaneous recovery (T4:T1 ratio 80 percent) were noted to be within the range of 63.48 - 103.48 minutes for cisatracurium whereas those treated with atracurium recovered within the range of 74.76 - 92.64 minutes and none necessitated reversal from the muscle relaxants. One patient from the cisatracurium group and two from the atracurium group were noted to have cutaneous flush. CONCLUSION: When given a dose of 3 x ED 95, except for onset, cisatracurium group did not differ significantly from the atracurium group with regard to onset, duration, intubating conditions, and hemodynamic stability.
Human ; Middle Aged ; Adult ; Young Adult ; Adolescent ; INTUBATION ; HEMODYNAMIC ; ANESTHESIA ; CISATRACURIUM ; ATRACURIUM ; HISTAMINE ; MUSCLE RELAXANTS, CENTRAL

Eperisone and afloqualone act by relaxing both skeletal and vascular smooth muscles to improve circulation and suppress pain reflex. These drugs are typically prescribed with non-steroidal anti-inflammatory drugs (NSAIDs) as painkillers. However, there have been no reports on serious adverse reactions to oral muscle relaxants; and this is the first report to describe three allergic reactions caused by eperisone and afloqualone. All three patients had histories of allergic reactions after oral intake of multiple painkillers, including oral muscle relaxants and NSAIDs, for chronic muscle pain. An open-label oral challenge test was performed with each drug to confirm which drugs caused the systemic reactions. All patients experienced the same reactions within one hour after oral intake of eperisone or afloqualone. The severity of these reactions ranged from laryngeal edema to hypotension. To confirm that the systemic reaction was caused by eperisone or afloqualone, skin prick testing and intradermal skin tests were performed with eperisone or afloqualone extract in vivo, and basophil activity tests were performed after stimulation with these drugs in vitro. In one patient with laryngeal edema, the intradermal test with afloqualone extract had a positive result, and CD63 expression levels on basophils increased in a dose-dependent manner by stimulation with afloqualone. We report three allergic reactions caused by oral muscle relaxants that might be mediated by non-immunoglobulin E-mediated responses. Since oral muscle relaxants such as eperisone and afloqualone are commonly prescribed for chronic muscle pain and can induce severe allergic reactions, we should prescribe them carefully.
Female ; Humans ; Hypersensitivity/*etiology ; Middle Aged ; Muscle Relaxants, Central/*adverse effects ; Propiophenones/adverse effects ; Quinazolines/adverse effects

Anesthesia ; methods ; Child ; Child, Preschool ; Female ; Foreign Bodies ; surgery ; Humans ; Infant ; Male ; Muscle Relaxants, Central ; therapeutic use ; Respiratory System

Belching is a normal physiological function that may occur when ingested air accumulated in the stomach is expelled or when food containing air and gas produced in the gastrointestinal tract is expelled. Excessive belching can cause patients to complain of abdominal discomfort, disturbed daily life activities, decreased quality of life and may be related to various gastrointestinal disorders such as gastroesophageal reflux disease, functional dyspepsia, aerophagia and rumination syndrome. Belching disorders can be classified into aerophagia and unspecified belching disorder according to the Rome III criteria. Since the introduction of multichannel intraluminal impedance monitoring, efforts are being made to elucidate the types and pathogenic mechanisms of belching disorders. Treatment modalities such as behavioral therapy, speech therapy, baclofen, tranquilizers and proton pump inhibitors can be attempted, but further investigations on the effective treatment of belching disorders are warranted.
Aerophagy ; Behavior Therapy ; Eructation/metabolism/*pathology/therapy ; Humans ; Muscle Relaxants, Central/therapeutic use ; Proton Pump Inhibitors/therapeutic use ; Quality of Life ; Speech Therapy

Aged ; Baclofen ; administration & dosage ; pharmacology ; therapeutic use ; Hiccup ; drug therapy ; Humans ; Male ; Muscle Relaxants, Central ; administration & dosage ; pharmacology ; therapeutic use ; Neoplasms ; surgery ; Young Adult

BACKGROUND: The ease and rapidity of endotracheal incubation depends highly on the degree of muscle relaxation. The tracheal intubating conditions following equipotent doses of rocuronium, succinylcholine and vecuronium under general anesthesia with halothane, oxygen and nitrous oxide were studied and evaluated in ninety patients undergoing surgery. METHODOLOGY: Ninety patients, ASA 1-2, were randomly allocated to three groups. Group A was designated to receive 0.6 mg/kg rocuronium intravenously (n=30), group B was designated to receive 1.0 mg/kg succinylcholine intravenously (n=30) and group C was designated to receive 0.1 mg/kg vecuronium intravenously (n=30). All patients were premedicated with nalbuphine and promethazine and received 5 mg/kg thiopental for induction of anesthesia. Sixty seconds after receiving a muscle relaxant, intubation of the trachea was attempted and intubating conditions were graded by the blinded observer. Constant neuromuscular function monitoring was made using a peripheral nerve stimulator. RESULTS: Intubating conditions, sixty seconds after administration of rocuronium were clinically acceptable and comparable with those observed after succinylcholine. Rocuronium produced good to excellent intubating conditions even in the presence of incomplete block of the adductor pollicis muscle. The lag and onset time of action are significantly faster than those of vecuronium. The duration of clinical relaxation with rocuronium is however similar to that of vecuronium. CONCLUSION: Rocuronium is a new intermediate acting non depolarizing muscle relaxant with a brief lag and onset time of action that offers good to excellent interesting conditions at 60 seconds comparable with that of succinylcholine. (Author)
Human ; Middle Aged ; Adult ; Young Adult ; Adolescent ; INTUBATION ; INTUBATION, INTRATRACHEAL ; HEART RATE ; BLOOD PRESSURE ; SUCCINYLCHOLINE ; VECURONIUM BROMIDE ; MUSCLE RELAXANTS, CENTRAL ; ROCURONIUM

AIM: Trichosanthes dioica Roxb. (Cucurbitaceae), commonly known as pointed gourd in English, is a dioecious climber grown widely in the Indian subcontinent. Traditionally, this plant has been used in India for several medicinal purposes. The present study aimed to evaluate certain neuropharmacological properties of the hydroalcoholic extract of T. dioica root (TDA) in experimental animal models. METHODS: TDA (at 100 and 200 mg·kg(-1) body weight, p.o.) was evaluated for anti-nociceptive activity by the acetic acid-induced writhing and tail flick methods. Locomotor depressant activity was measured by means of an actophotometer. Skeletal muscle relaxant effects were evaluated by using a rota-rod apparatus, and the sedative potentiating property by a phenobarbitone-induced sleep potentiation study. RESULTS: The results of the present study revealed significant (P < 0.001) and dose dependent anti-nociceptive, locomotor depressant, muscle relaxant, and sedative potentiating effects of TDA, demonstrating its depressant action on the central nervous system (CNS). CONCLUSION From the present study, it can be concluded that T. dioica root possessed prominent anti-nociceptive, as well as depressant, action on the CNS, as manifested by these important neuropharmacological properties in mice.
Analgesics ; administration & dosage ; Animals ; Central Nervous System Diseases ; drug therapy ; physiopathology ; Humans ; India ; Male ; Mice ; Muscle Relaxants, Central ; administration & dosage ; Muscle Relaxation ; drug effects ; Neuropharmacology ; Plant Extracts ; administration & dosage ; Plant Roots ; chemistry ; Trichosanthes ; chemistry

No abstract available.
Aged ; Anti-Infective Agents/therapeutic use ; Drug Therapy, Combination ; Foot Injuries/*complications ; Humans ; Male ; Muscle Relaxants, Central/therapeutic use ; Tetanus/diagnosis/drug therapy/*microbiology ; Tetanus Toxoid/therapeutic use ; Treatment Outcome ; Trismus/diagnosis/drug therapy/*microbiology ; Wounds, Stab/*complications

Tetanus is uncommon in Korea due to the introduction of vaccination programs and advances in public health. A case of maternal tetanus occurred on the 9 day postpartum in a 29-yr-old woman, who had not received a 10-yr-booster of tetanusdiphtheria toxoid after receiving the primary series of tetanus-toxoid-containing vaccine. There has hitherto been no reports on maternal tetanus in Korea. This case illustrates that tetanus remains a medical problem, principally among nonand underimmunized adults. The only way to fully prevent this disease is to ensure adequate immunization in all adults.
Adult ; Anti-Anxiety Agents/*therapeutic use ; Diazepam/*therapeutic use ; Female ; Humans ; Hypnotics and Sedatives/*therapeutic use ; Immunization, Passive ; Korea ; Muscle Relaxants, Central/*therapeutic use ; *Postpartum Period ; Tetanus/*drug therapy/etiology/physiopathology ; Treatment Outcome