Clinical Pharmacology of Rocuronium in Infants and Children

The main clinical use of the neuromuscular blocking agents is an adjuvant in surgical anaesthesia to obtain relaxation of skeletal muscle, particularly of the abdominal wall, to facilitate surgical manipulations. Rocuronium can be used instead of suxamethonium to provide rapid muscle paralysis during tracheal intubation but the recovery is much slower. Rocuronium is administered intravenously to infants and children. In infants, rocuronium is administered at a dose of 450 µg/kg for providing muscle relaxation for laryngeal intubation. To provide sustained paralysis, rocuronium is given at a dose of 600 µg/kg. In children, the neuromuscular blockade is obtained with 600 µg/kg followed by an intravenous infusion of 150 µg/kg per hour. For assisted ventilation in intensive care, rocuronium is administered at a dose of 600 µg/kg followed by an intravenous infusion of 300 to 600 µg/kg per hour. The effects of rocuronium have been extensively studied in infants and children. Rocuronium is converted into 17-desacetyl rocuronium. The pharmacokinetics of rocuronium have been studied in infants and children and the mean residence time is 55.6 and 25.6 min (P-value < 0.01) in infant and children, respectively. Rocuronium interacts with drugs, the treatment of infants and children with rocuronium has been studied, and rocuronium poorly crosses the human placenta. The aim of this study is to review the published data on rocuronium dosing, pharmacokinetics, and treatment in infants and children, and rocuronium metabolism and transfer across the human placenta.

Development and Feasibility Assessment of Virtual Reality-Based Relaxation Self-Training Program

Diaphragmatic breathing and progressive muscle relaxation (PMR) are an effective way for relaxation training and anxiety control, but their use is not common to the general public. Today, as the need for non-face-to-face contact increases, virtual reality (VR)-based self-training is gaining attention in public health. This study aimed to evaluate the feasibility of the newly developed VR-based relaxation training program. Both diaphragmatic breathing and PMR can be trained without an assistant using this VR application in three steps: 1) learning in a virtual clinic, 2) review in a comfortable virtual environment, and 3) practice in outdoor virtual environments. Self-training is recommended on a 3-weeks schedule with a total of 4–6 trials per day for 4 days a week. Thirty-one healthy volunteers were divided into the VR (n = 15) and worksheet (n = 16) groups, and participated in self-training under similar conditions as much as possible. Multiple evaluations were performed before, during, and after self-training. The change rates of all psychological and psychophysiological measures before and after self-training did not significantly differ between the two groups. The levels of tension after breathing practices showed no group difference, whereas those after PMR practices were significantly lower in the VR group than in the worksheet group. In the VR group, trials of outdoor practices tended to induce a decrease of the tension level, particularly after outdoor breathing trials. The VR group gave a practicable score of 70 points or more, average 43.5, and average 180.3 for usability, cybersickness, and presence of this program, respectively. These results suggest that the VR-based relaxation self-training program can be used by healthy people as a means of relaxation. In the use of this program, diaphragmatic breathing may be used more easily, but the benefit of using VR is higher in PMR. These findings provide justification for a randomized controlled study of whether this program can be used for stress relief in the general population and, furthermore, treatment of patients with anxiety disorders.

Pericapsular Nerve Group Block (PENG Block) and Spinal Anesthesia as Multimodal Analgetic in Patient with Bipolar Hip Arthroplasty: A Case Report

Introduction. Intertrochanteric fractures are defined as extracapsular fractures of the proximal femur that occur between the greater and lesser trochanter. Bipolar hip arthroplasty is one of the most common major orthopaedic procedures to improve patient’s functional status and quality of life. Spinal anesthesia is a regional anesthetic technique that is performed by injecting local anesthetic drugs into the subarachnoid space to obtain dermatome-level analgesia and skeletal muscle relaxation. Pain after hip replacement originates mainly from the anterior pelvic capsule. The main target for pelvic analgesia is the anterior capsule which is the most richly innervated part of the joint. PENG block is used to block the articular branches to the pelvis. The patient was assessed with an NRS (numeric rating scale) instrument pre and post operative. Case presentation. A-74 year old woman admitted with complaints of pain in the right hip and diagnosed with a closed fracture of the right intertrochanter and planned for bipolar hip arthroplasty with PENG block and spinal anesthesia. Preoperatively the patient was assessed with an NRS (numeric rating scale) instrument with a score of 6. After the procedure, we reevaluated the pain score using NRS was 2 post operative. Conclusion. Patients receiving a PENG block and spinal anesthesia for intraoperative and postoperative analgesia during hip fracture surgery. Prior to spinal anesthesia, PENG block can be performed as a multimodal analgesia in the patient, PENG block expected to facilitate a sitting position during spinal anesthesia and for postoperative pain management

Pelatihan Manajemen Stress Kepada Penderita Penyakit Kronis di Desa Warisa

ABSTRAK Penyakit kronis yang telah diderita selama bertahun-tahun dapat mengganggu pada semua aspek kehidupan penderitanya seperti masalah finansial, Karir, gangguan peran, termasuk masalah psikososial, akibatnya, penderita penyakit kronis seringkali juga mengalami stress kronis yang selanjutnya dapat memperburuk penyakit dan menurunkan kualitas hidup penderitanya. Di Desa Warisa didapatkan jumlah penderita penyakit kronis sebanyak 83 Orang hanya dari 3 jaga (lingkungan). Tujuan Pengabdian Kepada Masyarakat ini adalah untuk meningkatkan pengetahuan dan kemampuan penderita penyakit kronis di Desa Warisa terkait manajemen stress melalui kegiatan pelatihan. Kegiatan ini dilakukan dengan memberikan penyuluhan terkait manajamen stress yang baik dilanjutkan dengan pelatihan manajemen stress dengan relaksasi napas dalam dan relaksasi otot progresif. Kegiatan ini diikuti oleh 29 peserta termasuk 2 kader dan dari hasil evaluasi didapatkan peningkatan pengetahuan peserta sebesar 22.4% yaitu sebelum penyuluhan (63%) dan setelah penyuluhan (85.4%). Dari hasil observasi juga didapatkan sebagian besar peserta mampu melakukan kembali gerakan latihan relaksasi otot progresif secara mandiri namun, ada 5 Peserta yang belum mampu melakukan gerakan latihan secara mandiri yang kemudian diberikan pendampingan lanjutan. Hasil dari kegiatan ini diharapkan dapat menjadi dasar pembentukan program kesehatan jiwa di puskesmas khususnya terkait pelayanan psikososial bagi penderita penyakit kronis. Kata Kunci: Manajemen stress, Penyakit kronis, Relaksasi otot progresif ABSTRACT Chronic illness that has been suffered for years can interfere with all aspects of people with chronic illness such as financial problems, career, role performance, and psychosocial aspects. as a result, People who suffer from chronic diseases often experience chronic stress that worsens disease severity and reduces the quality of life. In Warisa Village, there were 83 people who were identified with chronic diseases from only 3 hamlets. The purpose of this Community Service was to increase the knowledge and ability of People with chronic disease in Warisa Village regarding stress management through training. This activity was carried out by delivering health education related to positive stress management followed by stress management training with deep breathing relaxation and Progressive Muscle Relaxation (PMR). This activity was attended by 29 participants including 2 Cadres and from the evaluation process, it was found that the participants' knowledge increased by 22.4% in which before counseling (63%) and after counseling (85.4%). From the observations, it was also found that most of the participants were able to perform PMR independently, however, there were 5 participants who had not been able to perform PMR independently and were then given further assistance. The results of this activity are expected to be the first step to developing mental health programs in Community Health Centers, especially related to psychosocial services for people with chronic diseases. Keywords: Stress management, Chronic illness, Progressive Muscle Relaxation

Control of Elderly Hypertension with Merona Program

Hypertension is a silent killer is the most common health problem experienced by the elderly. Control of hypertension in the elderly is very necessary to reduce complications of hypertension. Based on these conditions, the MERONA Program was developed. The purpose is to provide an overview of the implementation of the blush program in the elderly with hypertension. The method used is a family case study and an aggregate using a family and community nursing process approach involving 10 foster families and 60 elderly people in the community selected using cluster random sampling. This program is an integration of hypertension self-management and relaxation therapy, namely music therapy, progressive muscle relaxation, and deep breathing relaxation which is carried out for 12 weeks. Evaluation of changes in behavior and family independence was carried out at the end of the 12th week using a questionnaire. Blood pressure measurements were carried out at weeks 4, 8, and 12. The results of the implementation were an increase in the behavior of the elderly, an increase in the level of family independence, and a significant decrease in systolic and diastolic blood pressure (p<0.05). The MERONA program is recommended to be applied in community health services.

The effect of progressive muscle relaxation on reducing restless legs syndrome among patients undergoing haemodialysis in a satellite/hospital unit in Indonesia

Introducción: La relajación muscular se considera una terapia alternativa para el síndrome de las piernas inquietas (SPI). Objetivo: Determinar el efecto de la relajación muscular progresiva (RMP) sobre el síndrome de piernasinquietas en pacientes sometidos a hemodiálisis. Metodología: Se llevó a cabo un estudio con diseño cuasi-experimental en la unidad de hemodiálisis. Lamuestra reclutada fue de 12 encuestados tanto en el grupo de intervención como en el de control, siendo elmuestreo de conveniencia. El instrumento de investigación utilizado fue la Escala Internacional del Grupo de Estudio del SPI. Resultados: En el grupo de intervención, las puntuaciones medias del SPI antes y después fueron de22,92 y 17,42, respectivamente. En el grupo de control, las puntuaciones medias del SPI antes y despuésde la intervención fueron de 24,33 y 23,50, respectivamente. La RPM fue eficaz para mejorar el SPI (p<0,005). Conclusión: La RMP podría ser una alternativa para reducir el SPI en pacientes sometidos a hemodiálisis. Se necesitan estudios futuros para aclarar los hallazgos utilizando métodos más robustos y un tamaño de muestra mayor.

Shortening deactivation: quantifying a critical component of cyclical muscle contraction

A muscle undergoing cyclical contractions requires fast and efficient muscle activation and relaxation to generate high power with relatively low energetic cost. To enhance activation and increase force levels during shortening, some muscle types have evolved stretch activation (SA), a delayed increased in force following rapid muscle lengthening. SA's complementary phenomenon is shortening deactivation (SD), a delayed decrease in force following muscle shortening. SD increases muscle relaxation, which decreases resistance to subsequent muscle lengthening. While it might be just as important to cyclical power output, SD has received less investigation than SA. To enable mechanistic investigations into SD and quantitatively compare it to SA, we developed a protocol to elicit SA and SD from Drosophila and Lethocerus indirect flight muscles (IFM) and Drosophila jump muscle. When normalized to isometric tension, Drosophila IFM exhibited a 118% SD tension decrease, Lethocerus IFM dropped by 97%, and Drosophila jump muscle decreased by 37%. The same order was found for normalized SA tension: Drosophila IFM increased by 233%, Lethocerus IFM by 76%, and Drosophila jump muscle by only 11%. SD occurred slightly earlier than SA, relative to the respective length change, for both IFMs; but SD was exceedingly earlier than SA for jump muscle. Our results suggest SA and SD evolved to enable highly efficient IFM cyclical power generation and may be caused by the same mechanism. However, jump muscle SA and SD mechanisms are likely different, and may have evolved for a role other than to increase the power output of cyclical contractions.

Ensuring the effectiveness and safety of peripheral blockades

Adequate analgesia determines the success of the performed surgical intervention. In modern surgery, most of postoperative complications are directly related to ineffective therapy of pain syndrome in the perioperative period. The main principle of modern analgesia is its multicomponence, when analgesia, neurovegetative blockade and relaxation are achieved and potentiated by different drugs and methods. The blockade of nociceptive impulses with a local anesthetic at the transmission stage provides effective, targeted analgesia, hyporefl exia and muscle relaxation, prevents the sensitization of neuroaxial structures, hyperalgesia and the development of postoperative chronic pain syndrome. At the same time, providing analgesia with drugs of central action leads to the ineffectiveness of therapy in 80 % of cases, which has serious consequences.The aim. According to the literature review, to evaluate the effectiveness and safety of peripheral blockades on the example of performing a blockade of the pterygopalatine ganglion.Conclusion. The pterygopalatine blockade has broad indications for use in ophthalmology, which is explained by the complex structure of the pterygopalatine ganglion and the possibility of simultaneous infl uence on sympathetic, parasympathetic and nociceptive innervation. All the presented methods of pterygopalatine blockade performance have their advantages and disadvantages. Ultrasound navigation eliminates technical difficulties and the possibility of damage of the pterygopalatine fossa anatomical structures, ensuring the effectiveness and safety of the pterygopalatine blockade.

The effect of progressive muscle relaxation interventions on depression, stress, anxiety, and quality of life for cancer patients: a systematic review

Patients with cancer experience emotional distress which characterized by psychological symptoms such as anxiety or depression, psychological symptoms that arise and complex cancer processes have negative impact on their quality of life. Many cancer patients use a wide variety of techniques to improve their psychological symptoms and quality of life including relaxation therapy and specifically, Progressive Muscle Relaxation (PMR). The systematic review purpose was to review the evidence regarding the use of PMR intervention for cancer patients. Thirty four published studies and nine identified original article as potentially relevant , undertaken in the past six years until now (2013 to 2019) with data bases in Scopus, Proquest, Google Scholar, Oxford, and Science direct Searches. The information flow chart from record identification to study inclusion was conducted in accordance with the PRISMA and extracted data with PICOT. The impact of progressive muscle relaxation interventions remained in effect for between seven days and six month after the interventions.. Progressive muscle relaxation intervention is the technique including continous and systematic stretching and relaxing of the muscles until the whole body becomes relaxed. It has effects in improving depression, stress, anxiety and quality of life via physical relaxation.