Search Results (30)

Background: Neuromuscular blockade (NMB) is frequently used in moderate-to-severe acute respiratory distress syndrome (ARDS) to optimize ventilatory synchrony and minimize ventilator-induced lung injury. However, comparative real-world data on different NMB strategies remain limited. Objective: To describe patterns of neuromuscular blockade use in ARDS and describe clinical outcomes across four NMB strategies: intermittent rocuronium, continuous cisatracurium, escalation from rocuronium to cisatracurium, and de-escalation from cisatracurium to rocuronium. Methods: A retrospective chart review was conducted in an 18-bed tertiary ICU at Hôpital Montfort (Ottawa, Canada) between November 2021 and March 2025. Adult ARDS patients who received NMB for >24 h were included. Continuous variables (age, ventilation time, ICU stay) were summarized as means ± SD and median [IQR]; categorical variables (sex, ARDS etiology, mortality) as counts and percentages. Inferential testing was limited to baseline characteristics; clinical outcomes were summarized descriptively. Results: Fifty-one patients met inclusion criteria: rocuronium (n = 20), cisatracurium (n = 14), rocuronium→cisatracurium (n = 8), and cisatracurium→rocuronium (n = 9). Mean ventilation durations were 280, 195, 272, and 262 h, respectively; corresponding ICU stays were 245, 237, 380, and 299 h. Mortality ranged from 25% to 56%. Escalation from rocuronium to cisatracurium typically reflected persistent dyssynchrony or worsening oxygenation, whereas de-escalation occurred in improving patients with residual ventilatory drive. Variability in corticosteroid use, adjunctive proning, and epoprostenol were potential confounders. Conclusions: Distinct NMB use patterns in ARDS reflect bedside clinical judgment rather than predefined thresholds. Patient trajectory and dyssynchrony severity appear to drive NMBA escalation decisions more than oxygenation indices alone. These findings highlight the need for prospective studies defining standardized criteria for NMB initiation, escalation, and weaning in ARDS. Full article

Background/Objectives: Rapid sequence intubation (RSI) involves nearly simultaneous administration of a rapid-acting induction agent and a neuromuscular blocking agent (NMBA) to facilitate ideal intubation conditions. The NMBAs most commonly used for RSI are succinylcholine and rocuronium, which cause paralysis for 5–15 min and 45–70 min, respectively. Awareness with paralysis can occur in patients who are given longer-acting NMBAs with delayed initiation of post-intubation sedation or insufficient sedation depth. The previous literature has associated the use of rocuronium with a significantly longer time to sedation and analgesia. However, a recent study found no difference. The purpose of this study was to assess the association between paralytic agent choice and time to initiation of analgesia and/or sedation after RSI in the emergency department (ED) of a large tertiary care hospital. Methods: This study was an institutional review board (IRB)-approved, single-center, retrospective cohort evaluation of adult patients (≥18 years of age) who received succinylcholine or rocuronium following administration of an induction agent in the ED for RSI during the study time period. The primary outcome was time to initiation of post-intubation analgesia and/or sedation. Continuous data were analyzed by using Mann–Whitney U or Student’s t-test, and categorical data were analyzed using the Chi Square test or Fisher’s Exact test. Results: A total of 400 patients were included in this study. The median time to sedation with succinylcholine was 9 min compared to 14 min with rocuronium (p < 0.01). No significant differences were identified in the baseline characteristics or secondary outcomes related to induction agent choice or ED length of stay. Conclusions: The results of this study further support that the use of rocuronium for RSI is associated with a significantly longer time to sedation and/or analgesia, making emergency medicine provider awareness essential for minimizing the risks associated with inadequate post-intubation sedation. Full article

Neuromuscular blocking agents (NMBAs) are essential in intraocular surgeries to improve surgical conditions and ensure optimal ventilation. However, residual blockade can pose significant risks, particularly in pinnipeds due to their unique diving physiology. This case report describes the use of sugammadex for reversing rocuronium and AMG for monitoring neuromuscular block (NMB) in a California sea lion undergoing lensectomy. The objective is to evaluate the feasibility and safety of sugammadex for reversal of rocuronium-induced neuromuscular blockade and acceleromyography (AMG) for monitoring neuromuscular function in pinnipeds, with the goal of improving anesthetic management and recovery. Rocuronium (0.3 mg/kg IV) was used to achieve complete NMB, and an additional 0.1 mg/kg IV was administered to prolong the block. Sugammadex (1 mg/kg IV) reversed the NMB, with recovery within 90 s. Neuromuscular function was monitored using AMG, with the ulnar nerve of the foreflipper as the stimulation site. AMG allowed for an objective assessment of neuromuscular function, ensuring accurate titration of the NMBA and reversal agent. This is the first report documenting the use of sugammadex for the reversal of rocuronium and AMG for neuromuscular monitoring in a sea lion. This successful application highlights the potential of these techniques to improve anesthesia protocols, patient safety, and welfare in marine mammal medicine. Full article

Neuromuscular blocking agents such as atracurium and rocuronium are commonly used during anesthetic procedures in laboratory pigs. However, species-specific dosing guidelines remain limited, leading to reliance on data extrapolated from other species. This prospective, blinded study aimed to determine the equipotent dose for atracurium (A) and rocuronium (R) in laboratory pigs receiving propofol and to compare their cost-effectiveness. Twelve healthy animals were randomly distributed according to the drug administered (n = 6 per group). For both drugs, the infusion rate was adjusted following an up-and-down titration to maintain a train-of-four count between 3 and 4. Group differences were analyzed using the Wilcoxon signed-rank test. The bolus induction dose (mg/kg) was comparable between atracurium (2.3 [1.8–2.6]) and rocuronium (2 [2]), while atracurium was associated with higher costs (CHF/kg: A, 1.122 [0.878–1.366] versus R, 0.208 [0.208–0.208]; p = 0.002725). The maintenance infusion rate (mg/kg/h) was approximately 40% lower for atracurium (2.7 [2.5–2.8]) than for rocuronium (4.5 [4.4–4.5]; p = 0.004922), yet the maintenance cost (CFH/kg/h) remained higher for atracurium (A: 1.30 [1.22–1.37] versus R: 0.47 [0.45–0.47]; p = 0.0043). This study reports higher doses for anesthetized pigs compared to other species and demonstrates that rocuronium offers superior cost-effectiveness compared to atracurium under these experimental conditions. Full article

(1) Background: The aim of this bibliometric study is to analyze global research trends, citation impact, and scientific collaborations in the field of neuromuscular blockers (NMBAs) and their antagonists between 2000 and 2024. (2) Methods: Data were retrieved from the Web of Science Core Collection (WoSCC) using Boolean search strategies. Bibliometric analyses were conducted using R bibliometrix, VOSviewer, and CiteSpace software to visualize collaboration networks, keyword trends, and citation bursts. (3) Results: A total of 499 articles were analyzed, with the United States of America (USA), China, and South Korea leading in productivity, while France had the highest citation impact. Influential authors included Mertes PM and Fuchs-Buder T. Emerging topics such as sugammadex, sevoflurane, and neuromuscular monitoring were identified, reflecting a shift from pharmacokinetic studies to safety and monitoring strategies. (4) Conclusions: The findings indicate a marked increase in studies on neuromuscular monitoring and reversal agents, such as sugammadex, over the past two decades. The USA, France, and China emerged as the most contributory countries in NMBAs research, with their extensive international collaborations playing a pivotal role in shaping scientific progress. Highly influential studies have predominantly focused on NMBA pharmacokinetics, safety, anaphylaxis risks, and the clinical benefits of sugammadex, underscoring its critical role in reducing residual neuromuscular blockade (rNMB) and enhancing patient safety. Full article

Background/Objectives: Neuromuscular blocking agents (NMBAs) are not usually necessary during the induction of general anesthesia in patients using supraglottic airway (SGA) devices. In this study, we assessed the incidences of rocuronium use in adult patients undergoing general anesthesia using SGA devices. Methods: From September 2022 to August 2023, the medical records of adult patients (≥19 years) who underwent orthopedic surgery using SGA devices were retrospectively investigated. The incidences of rocuronium use during anesthetic induction were analyzed according to the anesthetic induction drug. The association of rocuronium use during anesthesia was analyzed in terms of demographic (age, sex, height, and weight), surgical (surgical time), and anesthetic factors (premedication, anesthetic agent, anesthetic time). Results: In total, 321 patients were enrolled. The incidence rate of rocuronium use during anesthetic induction was 28.3%. In the subgroup analysis, patients receiving total intravenous anesthesia (TIVA) with propofol (PPF) and remifentanil showed a markedly lower incidence (14.4%) than the other anesthetic groups. Premedication or short anesthetic duration was associated with lower incidences of rocuronium use. Demographic and other anesthetic factors did not seem to affect the incidences of rocuronium use during anesthesia. Conclusions: The incidence of rocuronium use during anesthetic induction with SGA devices was significantly lower with the PPF-TIVA compared to that using remimazolam-TIVA or inhalational anesthesia. Premedication with midazolam and shorter operation times were associated with a significantly lower incidence of rocuronium use. Full article

Neuromuscular blocking agents (NMBAs) are routinely used during anesthesia to relax skeletal muscle. Nicotinic acetylcholine receptors (nAChRs) are ligand-gated ion channels; NMBAs can induce muscle paralysis by preventing the neurotransmitter acetylcholine (ACh) from binding to nAChRs situated on the postsynaptic membranes. Despite widespread efforts, it is still a great challenge to find new NMBAs since the introduction of cisatracurium in 1995. In this work, an effective ensemble-based virtual screening method, including molecular property filters, 3D pharmacophore model, and molecular docking, was applied to discover potential NMBAs from the ZINC15 database. The results showed that screened hit compounds had better docking scores than the reference compound d-tubocurarine. In order to further investigate the binding modes between the hit compounds and nAChRs at simulated physiological conditions, the molecular dynamics simulation was performed. Deep analysis of the simulation results revealed that ZINC257459695 can stably bind to nAChRs’ active sites and interact with the key residue Asp165. The binding free energies were also calculated for the obtained hits using the MM/GBSA method. In silico ADMET calculations were performed to assess the pharmacokinetic properties of hit compounds in the human body. Overall, the identified ZINC257459695 may be a promising lead compound for developing new NMBAs as an adjunct to general anesthesia, necessitating further investigations. Full article

Naturally derived biopolymers modifying or combining with other components are excellent candidates to promote the full potential of additive manufacturing in biomedicine, cosmetics, and the food industry. This work aims to develop new photo-cross-linkable alginate-based inks for extrusion 3D printing. Specifically, this work is focused on the effect of the addition of cross-linkers with different chemical structures (polyethylene glycol diacrylate (PEGDA), N,N′-methylenebisacrylamide (NMBA), and acrylic acid (AA)) in the potential printability and physical properties of methacrylated alginate (AlgMe) hydrogels. Although all inks showed maximum photo-curing conversions and gelation times less than 2 min, only those structures printed with the inks incorporating cross-linking agents with flexible and long chain structure (PEGDA and AA) displayed acceptable size accuracy (~0.4–0.5) and printing index (Pr ~1.00). The addition of these cross-linking agents leads to higher Young’s moduli (from 1.6 to 2.0–2.6 KPa) in the hydrogels, and their different chemical structures results in variations in their mechanical and rheological properties. However, similar swelling ability (~15 swelling factor), degradability (~45 days 100% weight loss), and cytocompatibility (~100%) were assessed in all the systems, which is of great importance for the final applicability of these hydrogels. Full article

The use of neuromuscular blocking agents (NMBAs) is common in the intensive care unit (ICU). NMBAs have been used in critically ill patients with lung diseases to optimize mechanical ventilation, prevent spontaneous respiratory efforts, reduce the work of breathing and oxygen consumption, and avoid patient–ventilator asynchrony. In patients with acute respiratory distress syndrome (ARDS), NMBAs reduce the risk of barotrauma and improve oxygenation. Nevertheless, current guidelines and evidence are contrasting regarding the routine use of NMBAs. In status asthmaticus and acute exacerbation of chronic obstructive pulmonary disease, NMBAs are used in specific conditions to ameliorate patient–ventilator synchronism and oxygenation, although their routine use is controversial. Indeed, the use of NMBAs has decreased over the last decade due to potential adverse effects, such as immobilization, venous thrombosis, patient awareness during paralysis, development of critical illness myopathy, autonomic interactions, ICU-acquired weakness, and residual paralysis after cessation of NMBAs use. The aim of this review is to highlight current knowledge and synthesize the evidence for the effects of NMBAs for critically ill patients with lung diseases, focusing on patient–ventilator asynchrony, ARDS, status asthmaticus, and chronic obstructive pulmonary disease. Full article

(1) Background: The physiological and pharmacological variations between men and women are known to influence drug efficacy. The objective of this study was to determine the 50% and 95% effective doses (ED₅₀ and ED₉₅) of remimazolam required for i-gel supraglottic airway (ISA) insertion under remifentanil infusion without neuromuscular blocking agents (NMBAs) in both males and females. (2) Methods: Patients aged 19–65 years, scheduled for general anesthesia using ISA, were enrolled in this study. Patients were divided into two groups based on their sex. The anesthesia process began with a remifentanil infusion targeting an effect-site concentration of 3.0 ng/mL, accompanied by a remimazolam injection. The initial remimazolam dose was 0.25 mg/kg, and it was adjusted with a step size of 0.05 mg/kg based on the outcome of ISA insertion in the preceding patient. (3) Results: The ED₅₀ of remimazolam (mean ± standard error) was 0.28 ± 0.02 mg/kg in the male group and 0.18 ± 0.02 mg/kg in the female group (p < 0.001). Additionally, ED₉₅, which was calculated using the isotonic regression method, was significantly comparable between the male and female groups (male: 0.35 mg/kg, 95% confidence interval [CI] = 0.34–0.35; female: 0.29 mg/kg, 95% CI = 0.25–0.30). (4) Conclusions: This study showed that both the ED₅₀ and the ED₉₅ of remimazolam for successful ISA insertion was higher for men than that for women. Therefore, while using remimazolam alongside remifentanil infusion without NMBAs for ISA insertion, one should consider the patient’s sex for appropriate dosing. Full article

The present study reports the development and application of a rapid, low-cost in-situ method for the quantification of tartrazine in carbonated beverages using a smartphone-based colorimetric device with molecularly imprinted polymer (MIP). The MIP was synthesized using the free radical precipitation method with acrylamide (AC) as the functional monomer, N,N′-methylenebisacrylamide (NMBA) as the cross linker, and potassium persulfate (KPS) as radical initiator. The smartphone (RadesPhone)-operated rapid analysis device proposed in this study has dimensions of 10 × 10 × 15 cm and is illuminated internally by light emitting diode (LED) lights with intensity of 170 lux. The analytical methodology involved the use of a smartphone camera to capture images of MIP at various tartrazine concentrations, and the subsequent application of the Image-J software to calculate the red, green, blue (RGB) color values and hue, saturation, value (HSV) values from these images. A multivariate calibration analysis of tartrazine in the range of 0 to 30 mg/L was performed, and the optimum working range was determined to be 0 to 20 mg/L using five principal components and a limit of detection (LOD) of 1.2 mg/L was obtained. Repeatability analysis of tartrazine solutions with concentrations of 4, 8, and 15 mg/L (n = 10) showed a coefficient of variation (% RSD) of less than 6%. The proposed technique was applied to the analysis of five Peruvian soda drinks and the results were compared with the UHPLC reference method. The proposed technique showed a relative error between 6% and 16% and % RSD lower than 6.3%. The results of this study demonstrate that the smartphone-based device is a suitable analytical tool that offers an on-site, cost-effective, and rapid alternative for the quantification of tartrazine in soda drinks. This color analysis device can be used in other molecularly imprinted polymer systems and offers a wide range of possibilities for the detection and quantification of compounds in various industrial and environmental matrices that generate a color change in the MIP matrix. Full article

Pathogenic Escherichia coli (E. coli) remains a safety concern in the preservation and quality of green leafy vegetables. Sugar–lectin interactions provide a reliable, specific, and effective sensing platform for the detection of bacteria as compared to the tedious conventional plate counting technique. Herein, we present the synthesis of 4-(N-mannosyl) benzoic acid (4-NMBA) and 4-thiophenyl-N-mannose (4-TNM) via a two-step reductive amination for the detection of E. coli using a quartz crystal microbalance (QCM) biosensor. The 4-NMBA was synthesized with mannose and para-aminobenzoic (4-PBA), while the 4-TNM was synthesized with mannose and 4-aminophenyl disulfide (4-AHP) using water and acetic acid in a 1:1 ratio. The resultant structure of mannose derivatives (4-NMBA and 4-TNM) was characterized and confirmed using analytical tools, such as Mass Spectrometer, SEM, and FTIR. The choice of ligands (mannose derivatives) is ascribed to the specific recognition of mannose to the FimH lectin of the type 1 pilus of E. coli. Furthermore, the 4-PBA and 4-AHP conjugated to mannose increase the ligand affinity to FimH lectins. The setup of the QCM biosensor was composed of modification of the crystal surface and the covalent attachment of ligands for the detection of E. coli. The piezoelectric effect (frequency shift of the quartz) was proportional to the change in mass added to the gold crystal surface. Both the 4-NMBA- and 4-TNM-coated QCM sensors had a limit of detection of 3.7 CFU/mL and 6.6 CFU/mL with a sensitivity of 2.56 × 10³ ng/mL and 8.99 × 10⁻⁵ ng/mL, respectively, within the dynamic range of 10³ to 10⁶ CFU/mL. This study demonstrates the application of ligand-coated QCM biosensors as a cost-effective, simple, and label-free technology for monitoring pathogenic bacteria via molecular interactions on crystal surfaces. Full article

Water scarcity and the loss of fertilizer from agricultural soils through runoff, which also leads to contamination of other areas, are increasingly common problems in agriculture. To mitigate nitrate water pollution, the technology of controlled release formulations (CRFs) provides a promising alternative for improving the management of nutrient supply and decreasing environmental pollution while maintaining good quality and high crop yields. This study describes the influence of pH and crosslinking agent, ethylene glycol dimethacrylate (EGDMA) or N,N′-methylenebis (acrylamide) (NMBA), on the behavior of polymeric materials in swelling and nitrate release kinetics. The characterization of hydrogels and CRFs was performed by FTIR, SEM, and swelling properties. Kinetic results were adjusted to Fick, Schott, and a novel equation proposed by the authors. Fixed-bed experiments were carried out by using the NMBA systems, coconut fiber, and commercial KNO₃. Results showed that on the one hand, no significant differences were observed in nitrate release kinetics for any system in the selected pH range, this fact allowing to apply these hydrogels to any type of soil. On the other hand, nitrate release from SLC-NMBA was found to be a slower and longer process versus commercial potassium nitrate. These features indicate that the NMBA polymeric system could potentially be applied as a controlled release fertilizer suitable for a wide variety of soil typologies. Full article

Background: Although neuromuscular blocker agents (NMBAs) are recommended by guidelines as a treatment for ARDS patients, the efficacy of NMBAs is still controversial. Our study aimed to investigate the association between cisatracurium infusion and the medium- and long-term outcomes of critically ill patients with moderate and severe ARDS. Methods: We performed a single-center, retrospective study of 485 critically ill adult patients with ARDS based on the Medical Information Mart for Intensive Care III (MIMIC-III) database. Propensity score matching (PSM) was used to match patients receiving NMBA administration with those not receiving NMBAs. The Cox proportional hazards model, Kaplan–Meier method, and subgroup analysis were used to evaluate the relationship between NMBA therapy and 28-day mortality. Results: A total of 485 moderate and severe patients with ARDS were reviewed and 86 pairs of patients were matched after PSM. NMBAs were not associated with reduced 28-day mortality (hazard ratio (HR) 1.44; 95% CI: 0.85~2.46; p = 0.20), 90-day mortality (HR = 1.49; 95% CI: 0.92~2.41; p = 0.10), 1-year mortality (HR = 1.34; 95% CI: 0.86~2.09; p = 0.20), or hospital mortality (HR = 1.34; 95% CI: 0.81~2.24; p = 0.30). However, NMBAs were associated with a prolonged duration of ventilation and the length of ICU stay. Conclusions: NMBAs were not associated with improved medium- and long-term survival and may result in some adverse clinical outcomes. Full article

Background: Neuromuscular blocking agent (NMBA) monitoring and reversals are key to avoiding residual curarization and improving patient outcomes. Sugammadex is a NMBA reversal with favorable pharmacological properties. There is a lack of real-world data detailing how the diffusion of sugammadex affects anesthetic monitoring and practice. Methods: We conducted an electronic health record analysis study, including all adult surgical patients undergoing general anesthesia with orotracheal intubation, from January 2016 to December 2019, to describe changes and temporal trends of NMBAs and NMBA reversals administration. Results: From an initial population of 115,046 surgeries, we included 37,882 procedures, with 24,583 (64.9%) treated with spontaneous recovery from neuromuscular block and 13,299 (35.1%) with NMBA reversals. NMBA reversals use doubled over 4 years from 25.5% to 42.5%, mainly driven by sugammadex use, which increased from 17.8% to 38.3%. Rocuronium increased from 58.6% (2016) to 94.5% (2019). Factors associated with NMBA reversal use in the multivariable analysis were severe obesity (OR 3.33 for class II and OR 11.4 for class III obesity, p-value < 0.001), and high ASA score (OR 1.47 for ASA III). Among comorbidities, OSAS, asthma, and other respiratory diseases showed the strongest association with NMBA reversal administration. Conclusions: Unrestricted availability of sugammadex led to a considerable increase in pharmacological NMBA reversal, with rocuronium use also rising. More research is needed to determine how unrestricted and safer NMBA reversal affects anesthesia intraoperative monitoring and practice. Full article