Antibiotic-induced paralysis.
TL;DR: A clinically oriented analysis of the abstracts and a comprehensive bibliography comprise this review of medical literature over the past 15 years regarding neuromuscular blocking properties of certain antibiotic agents.
Abstract: SURVEY of medical literature over the A past 15 years has disclosed approximately 250 references to the neuromuscular blocking properties of certain antibiotic agents. A considerable portion of the articles appeared in clinical journals as case histories of protracted paralysis associated with acute administration of antimicrobial agents during anesthesia. Because of clinical and possible medicolegal implications of such pharmacologic misadventures, 111 case histories were abstracted and analyzed. A clinically oriented analysis of the abstracts and a comprehensive bibliography comprise this review.
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TL;DR: The Pharmacological Basis of Therapeutics, by Prof. Louis Goodman and Prof. Alfred Gilman, New York: The Macmillan Company, 1941, p.
Abstract: The Pharmacological Basis of Therapeutics A Textbook of Pharmacology, Toxicology and Therapeutics for Physicians and Medical Students. By Prof. Louis Goodman and Prof. Alfred Gilman. Pp. xiii + 1383. (New York: The Macmillan Company, 1941.) 50s. net.
2,686 citations
TL;DR: Commonly used antibacterial agents may be associated with various neurotoxic reactions and central nervous system toxicities include seizure disorders, encephalopathy, bulging fontanelles, and more.
Abstract: Commonly used antibacterial agents may be associated with various neurotoxic reactions. Central nervous system toxicities include seizure disorders, encephalopathy, bulging fontanelles, and neuropsychiatric symptoms. These abnormalities have been associated with the use of the penicillins, cephalosporins, sulfonamides, tetracyclines, chloramphenicol, colistin, aminoglycosides, metronidazole, isoniazid, rifampin, ethionamide, cycloserine, and dapsone. Cranial nerve toxicities, such as myopia, optic neuritis, deafness, vertigo, and tinnitus, have been associated with the use of erythromycin, sulfonamides, tetracyclines, chloramphenicol, colistin, aminoglycosides, vancomycin, isoniazid, and ethambutol. Peripheral nerve symptoms consisting of paresthesias, motor weakness, or sensory impairment have been associated with the use of the penicillins, sulfonamides, chloramphenicol, colistin, metronidazole, isoniazid, ethionamide, and dapsone. Neuromuscular blockade has been associated with the use of the tetracyclines, polymyxins, lincomycin, clindamycin, and aminoglycosides. Management generally consists of supportive therapy and immediate discontinuation of therapy with the offending drug.
209 citations
01 Jan 2010
TL;DR: One of the primary objectives for a patient with renal disease is ensuring that the renal dysfunction is not augmented and thereby increasing the chance for renal failure, coma, and death.
Abstract: • The history and physical examination most accurately predict the risks of anesthesia and the likelihood of required changes in monitoring or therapy. • For diabetic patients, end-organ dysfunction and the degree of glucose control in the perioperative and periprocedural periods are the critical issues with regard to risk. • The keys to managing blood glucose levels in diabetic patients perioperatively are to set clear goals and then monitor blood glucose levels frequently enough to adjust therapy to achieve these goals. • Obesity is associated with multiple comorbid conditions, including diabetes, hyperlipidemia, and cholelithiasis, but the primary concern is derangements of the cardiopulmonary system. • Obstructive sleep apnea is important to recognize because of the increased sensitivity to and the consequence of the depressing effects of hypnotics and opioids on airway muscle tone and respiration, as well as the difficulty with laryngoscopy and mask ventilation. • Although no controlled, randomized prospective clinical studies have been performed to evaluate the use of adrenergic receptor blocking drugs in patients undergoing resection of pheochromocytoma, the preoperative use of such drugs is generally recommended. • For patients with hypertension, the routine administration of all drugs preoperatively is recommended, except angiotensin-converting enzyme inhibitors and angiotensin II antagonists. • Evaluation of a patient with cardiovascular disease depends on clinical risk factors, the extent of surgery, and exercise tolerance. • In patients with pulmonary disease, the following should be assessed: dyspnea, coughing and the production of sputum, recent respiratory infection, hemoptysis, wheezing, previous pulmonary complications, smoking history, and physical findings. • In patients with pulmonary disease, several strategies have been suggested, including cessation of smoking 8 weeks or more preoperatively. • Risk factors for perioperative renal dysfunction include advanced age, congestive heart failure, previous myocardial revascularization, diabetes, and increased baseline blood creatinine concentration. • One of the primary objectives for a patient with renal disease is ensuring that the renal dysfunction is not augmented and thereby increasing the chance for renal failure, coma, and death. • Mild perioperative anemia may be clinically significant only in patients with ischemic heart disease. • Careful management of long-term drug administration should include questions about the effects and side effects of alternative as well as prescription drugs. Acknowledgment: The editors and the publisher would like to thank Dr. Michael F. Roizen, who was a contributing author to this topic in the prior edition of this work. It has served as the foundation for the current chapter.
126 citations
Journal Article•
TL;DR: The authors review the anesthetic considerations in the management of patients with myasthenia gravis who are undergoing thymectomy and other surgical procedures.
Abstract: Myasthenia gravis is a disease of great significance to the anesthesiologist, because it affects the neuromuscular junction. Many patients with this condition are treated by surgical thymectomy, using techniques developed by Mount Sinai physicians, including Dr. Paul Kirschner, Dr. Alan E. Kark, and the late Dr. Angelos E. Papatestas. The authors review the anesthetic considerations in the management of patients with myasthenia gravis who are undergoing thymectomy and other surgical procedures.
109 citations
TL;DR: The etiology of acute exacerbations of myasthenia gravis is not well understood and further characterization can lead to improved preventative measures, and factors contributing to MG exacerbations are characterized.
Abstract: INTRODUCTION The etiology of acute exacerbations of myasthenia gravis (MG) is not well understood and further characterization can lead to improved preventative measures. This study aims to characterize factors contributing to MG exacerbations. METHODS A total of 127 MG patient charts were reviewed retrospectively (2011-2016) to obtain demographics, immunizations, pharmaceutical records, contributing factors of each MG exacerbation, emergency department (ED) visits, hospitalizations, and duration. RESULTS There were 212 exacerbations requiring 106 ED visits and 141 hospitalizations (average admission 6.5 days). Highest contributors were infections (30%) and medications that may worsen MG (19%), with 24% unattributed. Infection related exacerbations were associated with 44.3% of ED visits and 39.7% of hospitalizations. Patients prescribed beta-blockers were associated with more exacerbations (P < .01). Patients prescribed medications that may worsen MG had a higher exacerbation frequency shortly after administration. DISCUSSION Infections and cautioned medications are frequently factors in acute MG exacerbations needing urgent medical attention and warrant caution.
82 citations
References
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TL;DR: The Pharmacological Basis of Therapeutics, by Prof. Louis Goodman and Prof. Alfred Gilman, New York: The Macmillan Company, 1941, p.
Abstract: The Pharmacological Basis of Therapeutics A Textbook of Pharmacology, Toxicology and Therapeutics for Physicians and Medical Students. By Prof. Louis Goodman and Prof. Alfred Gilman. Pp. xiii + 1383. (New York: The Macmillan Company, 1941.) 50s. net.
2,686 citations
TL;DR: The neuromuscular block produced by neomycine has been studied in the rat diaphragm and the frog sartorius by means of intra- and extracellular recording techniques and it is found that the block is due to a reduction in the amplitude of the end-plate potential.
Abstract: Elmqjvist, D. and J.-O. Josefsson. The nature of the neuromuscular block produced by neomycine. Acta physiol. scand. 1962. 54. 105–110. – The neuromuscular block produced by neomycine has been studied in the rat diaphragm and the frog sartorius by means of intra- and extracellular recording techniques. The block is due to a reduction in the amplitude of the end-plate potential. This reduction is partly caused by a neomycine induced decrease in the sensitivity of the postjunctional end-plate membrane to the depolarizing action of acetylcholine. Neomycine reduces the amount of transmitter released from the motor nerve in response to a nerve volley or to a high external potassium concentration. This prejunctional effect of neomycine is antagonized by an excess of Ca ions.
89 citations
TL;DR: Sufficient evidence now exists to confirm that colistimethate may be neurotoxic in humans, and added caution may dictate added caution in treating infections in patients with chronic debilitating diseases, chronic renal disease, hypoxic states, or those receiving muscle relaxants, adrenocorticosteroids, sedatives, narcotics, or anesthetic agents.
Abstract: Apnea, attributed to sodium colistimethate therapy, occurred in a 50-year-old Negro male. Sufficient evidence now exists to confirm that colistimethate may be neurotoxic in humans. Awareness of potential colistimethate toxicity may dictate added caution in treating infections in patients with chronic debilitating diseases, chronic renal disease, hypoxic states, or those receiving muscle relaxants, adrenocorticosteroids, sedatives, narcotics, or anesthetic agents.
53 citations
TL;DR: It is most important in the present age of antibiotics to choose the right m6dicines in the treatment of infections in myasthenic patients, also outside the crisis proper, in order to obtain as effective a stabilization as possible in the performance and medical equilibrium of these patients.
Abstract: The neuromuscular blocking properties of various antibiotics have been extensively studied since 1957. The reducing effect of some antibacterial medicines upon neuromuscular transmission seems to have been proved reliably. There are also many reports in the literature of the severe dyspnoeic complications caused by the potentiation of antibiotics and compounds with similar effects used in narcosis during operations. The importance of these facts has, however, not been sufficiently emphasized. The few words of warning which have been uttered have been directed to the anesthesiologists dealing with myasthenic patients, or, in general, to those who deal with acute crises (Herrmann (1961) , Foldes & McNall (1962) 1 . To our knowledge, no cases of aggravation of Myasthenia Gravis have been reported attributable to the use of antibiotics in myasthenics. In the author’s opinion, it is most important in the present age of antibiotics to choose the right m6dicines in the treatment of infections in myasthenic patients, also outside the crisis proper, in order to obtain as effective a stabilization as possible in the performance and medical equilibrium of these patients. As examples of this, some observations regarding the influence of streptomycin, dihydrostreptomycin and kanamycin upon some myasthenic patients are presented.
46 citations
TL;DR: The most important period during which intestinal bacterial inhibition should be maintained is theperiod of early healing, which coincides with the period of paralytic ileus when nothing can be taken orally.
Abstract: • The most important period during which intestinal bacterial inhibition should be maintained is the period of early healing, which coincides with the period of paralytic ileus when nothing can be taken orally. When an intestinal antiseptic is administered, the doses should not be spaced more than four hours apart, because the effective agent will be swept out of the small intestine. Unsustained suppression of bacterial growth favors the outgrowth of the resistant organisms. Because intestinal surroundings are ideal for the continued growth of bacteria, antibiotic agents must be maintained in unusually high concentrations.
45 citations