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Neuromuscular monitoring is therefore highly advisable. An alternative strategy would involve the use of a high dose of an opioid drug to reduce the patient's likelihood of movement or straining.An analog of gamma-aminobutyric acid (GABA), gabapentin is thought to exert its analgesic effect by modulating high-voltage calcium channels as well as interacting at the NMDA receptors.Gabapentin can be increased to a maximum dose of 3600 mg as side effects allow and efficacy dictates.Central nervous system side effects are similar to the other binding on the surfaces of post-synaptic cells.Thus, if the anesthesiologist is to rely on neuromuscular blocking drugs to prevent straining, unusually high doses must be administered.
Well absorbed orally, fatty food may decrease absorption and should be avoided when taking the drug.The clinical implication of profound resistance to neuromuscular blocking drugs in a patient undergoing neurosurgery is that it alters the strategies used to ensure that the patient does not strain or cough on the endotracheal tube at times when this would disrupt the surgery or place the patient at risk for harm.The anesthesiologist needs to be aware that the duration of action of normal doses of neuromuscular blocking drugs may be surprisingly short (or similarly, an infusion may have surprisingly little effect).For the benzylisoquinoline neuromuscular blocking drugs the evidence is less clear, with some studies reporting an effect and others not.These differences might be explained by the typical metabolism of these drugs.
Reports of painful urination and hematuria have also been associated with the use of tiagabine.