Search Results (132)

Background and Objectives: Obturator reflex during transurethral resection of bladder tumors (TURBT) can cause serious complications, such as bladder perforation, hemorrhage, and incomplete resection. Although obturator nerve block (ONB) is routinely recommended under spinal anesthesia, it is often omitted under general anesthesia (GA) based on the assumption that neuromuscular blockade (NMB) alone prevents adductor muscle contractions. However, clinical observations suggest that the obturator reflex may still occur under deep NMB. This study aimed to determine whether adductor longus muscle (ALM) contraction persists under GA with deep NMB during TURBT. Materials and Methods: Thirty patients scheduled for TURBT under GA were prospectively enrolled. A selective ONB was performed under ultrasound and nerve stimulator guidance. After establishing the baseline current intensity for ALM contraction, neuromuscular monitoring was initiated, and rocuronium (0.6 mg/kg) was administered. Stimulation thresholds required to induce ALM contraction were sequentially assessed at decreasing Train-of-Four ratio (TOFr) stages (90% to 10%) and Train-of-Four count (TOFc) stages (3 to 0). Final measurements were repeated 1 min after achieving TOFc 0. Changes in stimulation intensity were analyzed using a linear mixed-effects model (LMM). Results: As NMB deepened, the current intensity required to provoke ALM contraction progressively increased: 0.51 ± 0.25 mA at TOFr 90%, 1.66 ± 0.53 mA at TOFr 10%, 2.04 ± 0.66 mA at TOFc 0, and 2.61 ± 0.29 mA at 1 min after TOFc 0. Notably, all patients demonstrated ALM contraction at TOFc 0 and thereafter, confirming the persistence of the obturator reflex despite complete NMB. LMM analysis revealed a significant trend of increasing stimulation thresholds with progressive NMB depth (β = 0.133, p < 0.001). Conclusions: Adductor muscle contractions in response to obturator nerve stimulation persist even under deep NMB. These findings raise concerns that deep NMB alone may be insufficient to prevent obturator reflex and suggest that ONB should be considered as an adjunctive practice during TURBT under GA in patients at risk. 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

Background: Tracheal intubation and mechanical ventilation are facilitated by neuromuscular blocking agents. We investigated the effectiveness of subjective clinical evaluation of neuromuscular function on retroglossal area size, since it determines spontaneous ventilation adequacy following tracheal extubation. Secondarily, we correlated changes in retroglossal area and depth of neuromuscular block assessed during both respiratory phases using quantitative neuromuscular monitoring. Methods: Once mechanical ventilation was no longer needed, antagonists were used to reverse the neuromuscular block in 21 consenting patients; adequacy of reversal was assessed subjectively by delivering a sequence of four rapid (2 Hz) electrical stimuli (train-of-four, TOF) to a peripheral nerve and assessing attainment of four equal muscle contractions (TOF ratio = 1.0), signifying normal neuromuscular function. Retroglossal area during both inhalation and exhalation were measured pharyngoscopically at various phases of neuromuscular recovery, including at baseline after anesthesia induction but before neuromuscular block onset and at recovery before tracheal extubation; area changes were correlated with depth of quantitatively measured neuromuscular block. Results: Clinicians’ subjective evaluation of readiness for tracheal extubation failed to identify significant residual block in most patients who required rescue antagonism. Markedly decreased retroglossal areas (inhalation: 39.5% of baseline; exhalation: 20.1% of baseline) were present at extubation, and 11 out of 21 (52.4%) patients needed rescue antagonism. In contrast, in patients with neuromuscular recovery to the currently recommended threshold determined quantitatively (TOF ratio > 0.90), retroglossal areas were only 80% recovered but returned to near baseline values when the TOF ratio ≥ 0.95. Conclusions: Quantitative monitoring should guide the timing of tracheal extubation. Current definitions of the minimal threshold for adequate neuromuscular recovery (TOF ratio > 0.90) after mechanical ventilation in postoperative patients should be re-evaluated. A TOF ratio > 0.95 better correlates with return to normal (baseline) retroglossal area during both inhalation and exhalation. Full article

This study examined the use of linear regression models for predicting the outcomes of a six-week velocity-based training (VBT) intervention in female floorball players. The intervention was integrated into regular training and consisted of brief 30-min sessions focused on back squats and trap bar deadlifts. Key performance metrics included neuromuscular adaptation, sprint speed, jump performance, stop-and-go (SAG) performance, and load-velocity profiles. Seventeen participants completed 12 training sessions, a strength block set (Sessions 1–6) and a power block set (Sessions 7–12). The predictive models explained 54% to 79% ($R^2$ = 0.54–0.79) of the performance improvement in the strength-related tests. Significant gains were observed in neuromuscular metrics, including estimated one-repetition maximum (1${\mathrm{RM}}_{est}$) and average mean concentric velocity for both exercises. These findings underscore the predictive potential of VBT in enhancing strength and power while highlighting the need to integrate task-specific exercises to optimize sport-specific performance. This study provides valuable insights for tailoring VBT strategies for female athletes in high-demand team sports such as floorball. Full article

Objectives: Interval block resistance training (IBRT) and circuit resistance training (CRT) are periodization models aimed at enhancing neuromuscular and metabolic adaptations. This study aims to evaluate the effects of a 12-week IBRT program compared to CRT on body composition, muscle strength, speed, functional capacity, and autonomic recovery in young Chilean adults. Methods: A randomized, parallel, double-blind study was conducted with 30 participants assigned to IBRT (n = 15) or CRT (n = 15). Assessments included body mass index (BMI), waist circumference, right-hand grip strength, the running anaerobic sprint test (RAST), the 6 min walk test (6 MWT), and heart rate variability (HRV) indices: low-frequency to high-frequency ratio (LF/HF) and root mean square of successive differences (RMSSD, a time-domain HRV metric reflecting parasympathetic activity). Statistical analyses included t-tests and ANCOVA. Results: Groups were similar in age (IBRT: 25.2 ± 3.19; CRT: 23.27 ± 3.69, p = 0.14) and BMI (IBRT: 21.56 ± 2.22; CRT: 22.36 ± 1.70 kg/m², p = 0.40). Both groups improved significantly in waist circumference (IBRT: −1.85%; CRT: −2.37%), grip strength (IBRT: +5.47%; CRT: +4.02%), RAST (IBRT: −2.67%; CRT: −1.04%), 6 MWT (IBRT: +4.53%; CRT: +2.17%), LF/HF (IBRT: −11.43%; CRT: −5.11%), and RMSSD (IBRT: +5.36%; CRT: +3.81%) (all p ≤ 0.01). IBRT produced significantly greater gains in 6 MWT (B = 19.51, 95% CI: 0.79 to 38.23, p = 0.04). Conclusions: Both IBRT and CRT effectively improved body composition, muscle strength, speed, functional capacity, and autonomic recovery. However, IBRT demonstrated a superior effect on aerobic capacity. 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: Intraoperative nerve monitoring (IONM) is increasingly recognized as an essential technique in thyroid surgery to preserve the integrity of the recurrent laryngeal nerve (RLN) and prevent postoperative complications. Although widely adopted, several technical and anesthetic factors can significantly affect the reliability and interpretation of electromyographic (EMG) signals. Methods: This narrative review summarizes the principles and methodologies of IONM in thyroid surgery, focusing on the mechanisms of RLN injury, the clinical benefits of IONM, and its limitations. Particular emphasis is placed on the anesthesiologic considerations, including the effects of neuromuscular blocking agents and anesthetic maintenance methods for EMG signal quality. Recent advances in alternative IONM techniques are also discussed. Results: IONM facilitates early detection of RLN injury and improves surgical outcomes. However, signal loss and technical errors occur in up to 23% of cases. Appropriate anesthetic management, such as the judicious use of neuromuscular blocking agents and the use of reversal agents like sugammadex, can significantly improve IONM accuracy. Alternative approaches, such as transcutaneous or thyroid cartilage electrode-based monitoring, show promise in overcoming current limitations. Conclusions: IONM is a valuable tool in modern thyroid surgery, aiding in the prevention of RLN injury. Anesthesiologists play a crucial role in optimizing IONM quality by managing factors that affect EMG signals. Ongoing research into novel monitoring techniques is expected to further enhance patient safety and surgical precision. Full article

This Critical Appraisal aims to explore the pharmacokinetics and pharmacodynamics of medications used in organ donors after euthanasia (ODE) and their impact on abdominal organ quality. With the legalization of ODE, the donor pool has expanded, but it has introduced complexities regarding organ quality. This study evaluates existing euthanasia protocols in the Netherlands, Belgium, Spain, and Canada, focusing on differences in the medication types and dosages. Additionally, a literature review assessed the potential hepatotoxic effects of high-dose medications like thiopental, propofol, and non-depolarizing neuromuscular blocking agents. High doses of non-depolarizing neuromuscular blocking agents, particularly rocuronium, are associated with hepatotoxic effects in vitro. Furthermore, thiopental doses exceeding 750 mg significantly increase the risk of liver dysfunction. Recent findings also indicate that high-dose propofol and lidocaine can slightly prolong the time to death, which is crucial for optimizing organ viability in ODE. This study highlights the need to optimize organ donation procedures after euthanasia. Further research is needed to achieve this balance, maintaining the integrity and ethical standards of the euthanasia process while enhancing the outcomes of organ donation. Full article

Myofascial pain syndrome (MPS) is a common musculoskeletal disorder that significantly affects quality of life. Conventional treatment approaches include pharmacological interventions, physical therapy, and procedures such as dry needling. Among these, ultrasound-guided injections (USGIs) have gained recognition for their precision and therapeutic benefits. Additionally, repetitive peripheral magnetic stimulation (rPMS) has emerged as a non-invasive neuromodulatory technique for pain management. This perspective article examines the physiological mechanisms and clinical applications of USGIs and rPMS, particularly in the lumbar multifidus muscle, and explores their potential synergistic effects. MPS is often associated with chronic muscle dysfunction due to energy depletion, leading to persistent pain and motor impairment. USGIs play a crucial role in restoring muscle perfusion, disrupting pain cycles, and providing diagnostic insights in real time. In parallel, rPMS modulates neuromuscular activation, enhances endogenous pain control, and promotes functional recovery. Ultrasound guidance enhances the precision and effectiveness of interventions, such as dry needling, interfascial plane blocks, and fascial hydrodissection, while rPMS complements these strategies by facilitating neuromuscular reconditioning and reducing pain via central and peripheral mechanisms. The preliminary findings suggest that combining multifidus USGIs with rPMS results in significant pain relief and functional improvements in patients with chronic low back pain. Integrating USGIs with rPMS represents a promising multimodal strategy for managing MPS. By combining targeted injections with non-invasive neuromodulation, clinicians may optimize therapeutic outcomes and provide sustained relief for patients with chronic musculoskeletal pain. Further research is needed to refine treatment protocols and assess the long-term efficacy. Full article

Background: Neuromuscular blocking agents play an important role in modern anesthesia by facilitating optimal surgical conditions through deep muscle relaxation. Additionally, neuromuscular monitoring and reversal ensure swift and reliable recovery from neuromuscular blockade. The evolution of neuromuscular blocking agents, from early curare derivatives to contemporary agents such as rocuronium and cisatracurium, has significantly enhanced the safety and efficacy of anesthesia. Methods: This review examines the historical development, pharmacological mechanisms, clinical applications, and innovations in managing neuromuscular blockade. Results: It underscores key milestones in the advancement of neuromuscular blockade, including the introduction of neuromuscular monitoring techniques like Train-of-Four, which improve patient safety by reducing residual neuromuscular blockade. Pharmacological advancements, particularly the emergence of sugammadex, have further revolutionized clinical practice by enabling rapid and reliable reversal of steroidal neuromuscular blocking agents. The discussion covers the role of deep neuromuscular blockade in optimizing surgical conditions, especially in minimally invasive procedures. Conclusion: Comparative analyses of standard versus deep blockade reveal potential advantages in certain surgical scenarios, although patient-specific factors and associated risks must be carefully evaluated. Future directions involve developing innovative neuromuscular blocking agents and reversal agents aimed at achieving faster onset, shorter duration, and fewer side effects. The management of neuromuscular blockade continues to evolve, propelled by advancements in pharmacology and monitoring technology. Anesthesiologists should embrace a personalized approach, integrating advanced monitoring tools and customized pharmacological strategies to enhance patient outcomes. Ongoing research into next-generation neuromuscular blocking agents and reversal agents holds the promise of further improving safety and efficiency in anesthesia practice. Full article

Biomedical sciences have made immense progress and numerous discoveries aimed at improving the quality of life and life expectancy in modern times. Anesthesiology is typically tailored to individual patients as its clinical effects depend on multiple factors, including a patient’s physiological and pathological states, age, environmental exposures, and genetic variations. Sex differences are also paramount for a complete understanding of the effects of specific anesthetic medications on men and women. However, women-specific research and the inclusion of women in clinical trials, specifically during child-bearing years, remain disproportionately low compared to the general population at large. This review describes and summarizes genetic variations, including sex differences, that affect responses to common anesthetic medications such as volatile anesthetics, induction agents, neuromuscular blocking drugs, opioids, and local anesthetics. It also discusses the influence of genetic variations on anesthesia outcomes, such as postoperative nausea and vomiting, allergic reactions, pain, depth of anesthesia, awareness under anesthesia and recall, and postoperative delirium. Full article

The purpose was to design and validate a battery of physical tests, called EFEPD-1.0, adapted to assess functionality in people with disabilities. In addition, we sought to analyze the validity and reliability of this battery both for the total group and differentiated by sex. A total of 43 adults with disabilities (32 women and 11 men) participated (57.11 ± 10.12 years). The battery was composed of five blocks of functionality: neuromuscular, combined actions, acceleration, balance, and cardiovascular. The neuromuscular functionality was measured by the vertical and horizontal jump test using the optical system (Opto Jump Next^®, Microgate, Bolzano, Italy) as well as the Hand Grip (HG) test using a (5030J1, Jamar^®, Sammons Preston, Inc, Nottinghamshire, UK) hand dynamometer. The combined actions and balance functionality were assessed with the Time Up and Go (TUG) test, the 30 s Chair Stand (30CTS) test, and the One-Leg Stance (OLS) test measured by a manual stopwatch (HS-80TW-1EF, Casio^®, Tokyo, Japan). The acceleration functionality was evaluated through 20 m sprints and the 505 change of direction (COD505) test, using the (Microgate, Witty^®, Bolzano, Italy) photocell system. The cardiovascular functionality was evaluated with the Six-Minute Walking Test (6MWT), where heart rate was monitored using the (Polar Team Sport System^®, Polar Electro Oy, Kempele, Finland), and additional walking mechanics were recorded with Stryd (Stryd Everest 12 Firmware 1.18 Software 3, Stryd Inc., Boulder, CO, USA). The results showed that the intraclass correlation coefficients (ICCs) ranged from moderate to almost perfect (ICC = 0.65–0.98) between test repetitions. Some tests could significantly differentiate (p < 0.05) men and women, highlighting better neuromuscular capacity in men and better balance in women. The correlations between tests showed significant convergent validity. The Evaluation of Functionality in the Disabled Population (EFEPD-1.0) battery not only consistently measures functional capacities in people with disabilities, but it can also discriminate between different subgroups within this population. Full article

The current opinion manuscript posits that not only Piezo2 voltage block, but also proton affinity and availability in relation to Piezo2, a mechanically gated ion channel, may count in the mediation of pain and its sensitivity. Moreover, this paper argues that autonomously acquired Piezo2 channelopathy on somatosensory terminals is likely the initiating peripheral impaired input source that drives the central sensitization of spinal nociceptive neurons on the chronic path as being the autonomous pain generator. In parallel, impaired proprioception and the resultant progressive deficit in neuromuscular junctions of motoneurons might be initiated on the chronic path by the impairment of the proton-based ultrafast proprioceptive feedback to motoneurons due to disconnection through vesicular glutamate transporter 1. The irreversible form of this autonomously acquired Piezo2 ion channel microdamage, in association with genetic predisposition and/or environmental risk factors, is suggested to lead to progressive motoneuron death in addition to loss of pain sensation in amyotrophic lateral sclerosis. Furthermore, the impairment of the proton-based ultrafast long-range oscillatory synchronization to the hippocampus through vesicular glutamate transporter 2 may gain further importance in pain modulation and formation on the chronic path. Overall, this novel, unaccounted Piezo2-initiated protonic extrafast signaling, including both the protonic ultrafast proprioceptive and the rapid nociceptive ones, within the nervous system seems to be essential in order to maintain life. Hence, its microdamage promotes neurodegeneration and accelerates aging, while the complete loss of it is incompatible with life sustainment, as is proposed in amyotrophic lateral sclerosis. Full article

Background and Objectives: Neuromuscular blocking agents are essential to ensure optimal surgical conditions during general anesthesia. Sugammadex, a selective binding agent, is widely used to reverse neuromuscular blockade. While weight-based dosing (2 mg/kg for moderate blockade) is recommended, many clinicians administer a fixed dose of 200 mg in clinical practice, potentially leading to overdosing. This study aimed to compare the efficacy and recovery profiles of weight-based and fixed-dose sugammadex in patients undergoing general anesthesia. Materials and Methods: In this randomized controlled trial, 20 patients were divided into two groups: the recommended dose group (R group, 2 mg/kg) and the fixed dose group (F group, 200 mg). Primary outcomes included time to achieve a normalized train-of-four (TOF) ratio of 0.9. Secondary outcomes included recovery time, time to spontaneous respiration, response to verbal commands and extubation, and adverse events. Results: The median time to achieve a normalized TOF ratio of 0.9 was 2.3 min in the R group and 2.0 min in the F group (p = 0.529). Secondary outcomes, including recovery time and time to extubation showed no significant differences. Adverse events were minimal and comparable between groups. Conclusions: The fixed-dose sugammadex (200 mg) demonstrated similar efficacy and safety to weight-based dosing (2 mg/kg) in reversing moderate neuromuscular blockade. These findings do not allow abandoning the recommendation of adjustment for body weight, particularly in patients with low body weight or comorbidities. Full article

Background/Objectives: Charcot first described ALS in 1869, but the specific mechanisms that mediate the disease pathology are still not clear. Intense research efforts have provided insight into unique neuroanatomical regions, specific neuronal populations and genetic associations for ALS and other neurodegenerative diseases; however, the experimental results also suggest a convergence of these events to common toxic pathways. We propose that common toxic pathways can be therapeutically targeted, and this intervention will be effective in slowing progression and improving patient quality of life. Here, we focus on understanding the role of IL6 trans-signaling in ALS disease processes. Methods: We leveraged unique mouse models of IL6 trans-signaling that we developed that recapitulate the production of active sIL6R in a genotypic and quantitative fashion observed in humans. Given that the SOD1 transgenic mouse is one of the most highly studied and characterized models of ALS, we bred SOD1^G93A mice with IL6R trans-signaling mice to determine how enhanced trans-signaling influenced symptom onset and pathological processes, including neuromuscular junction (NMJ) denervation, glial activation and motoneuron (MN) survival. Results: The results indicate that in animals with enhanced trans-signaling, symptom onset and pathological processes were accelerated, suggesting a role in disease modification. Administration of an IL6R functional blocking antibody failed to alter accelerated symptom onset and disease progression. Conclusions: Future work to investigate the site-specific influence of enhanced IL6 trans-signaling and the tissue-specific bioavailability of potential therapeutics will be necessary to identify targets for precise therapeutic interventions that may limit disease progression in the 60% of ALS patients who inherit the common Il6R Asp³⁵⁸Ala variant. Full article