Malignant hyperthermia-update.

Cases of intraoperative hyperkalaemia in healthy greyhound dogs under general anaesthesia have previously been reported in veterinary literature. This case report describes the identification and treatment of hyperkalaemia in an otherwise healthy greyhound undergoing general anaesthesia for a fracture repair. The clinical signs were sudden bradycardia and loss of P waves on the electrocardiogram waveform. Treatment consisted of intravenous 10% calcium gluconate, rapid recovery from anaesthesia, intravenous glucose administration and continued serum potassium monitoring postoperatively. Potential aetiologies of the hyperkalaemia are discussed. 

https://onlinelibrary.wiley.com/doi/pdfdirect/10.1002/vrc2.585

Hyperkalaemia in a greyhound under general anaesthesia

Background Widely used in anesthetic management, sugammadex is increasingly employed in the reversal of neuromuscular blocking agents (NMBAs) in the emergency department and critical care arena, where little evaluative data currently exists. This study explored the utility and safety of using sugammadex to facilitate neurologic assessments in critically ill, NMBA-exposed patients. Methods We pursued a retrospective case series and single-arm cohort analysis of all brain-injured patients receiving sugammadex to facilitate neurologic evaluation during one year at a high-volume Level 1 trauma center. The primary outcome was the qualitative impact of sugammadex administration on neurosurgeon decision-making. Secondary outcomes included the change to Glasgow Coma Scale (GCS) and hemodynamic parameters compared before and after sugammadex administration. Sugammadex dosing was also assessed across various weight scalars to explore dose-response trends and generate preliminary guidance for use in this setting. Results Our study criteria yielded 12 sugammadex administrations across 11 patients, the majority of whom had sustained a traumatic brain injury. All sugammadex administrations were adjudicated as beneficial to neurosurgeon decision-making and 50% were associated with a change to prognosis and plan. Sugammadex was associated with an increase in the GCS of 1-8 points among the 67% of patients who responded. Mean arterial pressure decreased significantly after sugammadex administration (median 94 vs. 104 mmHg, p=0.0215, median change of -8 mmHg [95%CI -25-3 mmHg]). No apparent dose-response trends were observed for changes to GCS or hemodynamic parameters. Conclusions The use of sugammadex to facilitate neurologic assessment after NMBA exposure in brain-injured patients was frequently associated with clinically meaningful changes to the neurologic exam and treatment plan. The risks of hemodynamic compromise and care complexity should be collaboratively weighed before pursuing this modality. An empiric sugammadex dose of 200 mg appears reasonable for this purpose, but further evaluation of NMBA reversal in the neurocritically ill outside of procedural settings is warranted.

/pdf/sugammadex-to-facilitate-neurologic-assessment-in-severely-2rzjqavs.pdf

Sugammadex to Facilitate Neurologic Assessment in Severely Brain-Injured Patients: A Retrospective Analysis and Practical Guidance

Cystic fibrosis is an autosomal recessive disorder that causes a broad range of clinical findings and can present unusually as electrolyte disturbance, such as hyponatremia that causes seizures in children.We report a case of a 2-month-old infant who presented with an episode of grand mal seizure induced by hyponatremia and moderate episodes of milky vomiting after breastfeeding.Proper investigations showed normal cardiac and renal functions. Ultrasonography showed no pathological changes. Laboratory tests performed showed hyponatremia, mild hypokalemia, and hypochloremia. Urinary electrolyte results were normal. While broadening the scope of differential diagnosis in order to reach a final diagnosis, the sweat chloride level was elevated, which confirmed the diagnosis of cystic fibroses.We aim to share our case to keep cystic fibroses in mind as a differential diagnosis when dealing with hyponatremic seizures in children. 

A unique presentation of hyponatremia and seizures in a 2-month-old child with cystic fibrosis: a case report

Despite the availability of various methods to improve the solubility, stability, and bioavailability of drugs, the issue of low bioavailability due to poor water solubility persists. Cyclodextrins (CDs) inclusion technology has emerged as a safe and effective method for enhancing the solubility of insoluble drugs. While the technology is well-established, the pharmaceutical application of CDs still has significant untapped potential. This paper presents a comprehensive review of the physicochemical properties, preparation methods, pharmacokinetics, toxicology, and pharmaceutical applications of CDs, inclusion complexes, and aggregates. The review highlights recent advances in the field, including the development of large-ring CDs and the optimization of preparation methods and synthesis routes. The paper also emphasizes the potential of CDs as a versatile tool for drug delivery, with particular emphasis on novel approaches such as the functionalization of CDs for use as gene and protein vaccine delivery systems. This paper offers valuable insights into the current state-of-the-art and identifies future research directions for the development of CDs and their inclusion complexes for drug delivery. 

Cyclodextrins in Drug Delivery: Unlocking Potential Through Inclusion Complexes and Novel Applications

Sugammadex to Reverse Neuromuscular Blockade Prior to Withdrawal of Life Support.

Hyperkalemia, defined as a serum or plasma potassium greater than 5.5 mEq/L, while an uncommon occurrence in children, is a serious medical problem that warrants immediate attention as it can result in serious cardiac arrhythmias and death. Although hyperkalemia may occur in the critically ill patient or in the setting of renal failure and insufficiency, there are limited reports of its occurrence during intraoperative care. The authors report a previously healthy, 18-year-old patient, who developed hyperkalemia intraoperatively during posterior spinal fusion to treat adolescent idiopathic scoliosis. The potential etiologies of hyperkalemia are reviewed, a differential diagnosis for the possible etiologies presented, and treatment modalities discussed. J Med Cases. 2020;11(6):152-156 doi: https://doi.org/10.14740/jmc3470

/pdf/etiology-and-treatment-of-intraoperative-hyperkalemia-during-1zslofhnhd.pdf

Etiology and Treatment of Intraoperative Hyperkalemia During Posterior Spinal Fusion in an Adolescent.

Hyponatremia is one of the most commonly encountered electrolyte abnormalities encountered in the pediatric world. Defined as a serum or plasma sodium less than 135 mEq/L, the etiology of hyponatremia is one that can typically be determined by performance of a thorough history. However, occasionally the etiology of a patient's hyponatremia is more elusive and determined only after laboratory evaluation. We present a 6-year-old girl with a complex medical history including spinal muscular atrophy, tracheostomy and ventilator dependence, who was admitted to the pediatric intensive care unit for treatment and evaluation of seizures with hyponatremia that was initially thought to be due to syndrome of inappropriate anti-diuretic hormone or cerebral salt wasting. However, during her hospital course, it was determined that the hyponatremia was more indicative of a rarer and much less common cause of hyponatremia, hyporeninemic-hypoaldosteronism. The physiological factors controlling serum sodium are reviewed, the etiologies of hyponatremia are presented and the treatment of hyporeninemic-hypoaldosteronism is discussed.

Hyponatremia and Hyporeninemic-Hypoaldosteronism in a Pediatric Intensive Care Unit Patient.

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Papers

Sugammadex to Reverse Neuromuscular Blockade Prior to Withdrawal of Life Support.

Etiology and Treatment of Intraoperative Hyperkalemia During Posterior Spinal Fusion in an Adolescent.

Hyponatremia and Hyporeninemic-Hypoaldosteronism in a Pediatric Intensive Care Unit Patient.