An illicit-substance-using patient undergoing arthroscopic shoulder reconstruction with continuous interscalene brachial plexus blockade as primary anesthetic technique and dexmedetomidine as sedating agent

This is the case of a 22-year-old male student actively involved in mixed martial arts (MMA) with a history od recurrent dislocation of both shoulder joints since he was 16 years old; most recent of which is twisting of his right shoulder one month prior to admission. Personal history revealed two years regular use of illicit substances such as marijuana and methamphetamine as well as the non-medical use of oral diazepam and intramuscular meperidine. He subsequently underwent arthroscopic right shoulder reconstruction in the beach chair position under continuous interscalene brachail plexus block with dexmedetomidine infusion for sedation.

An exploratory study on the neuromuscular junction activity of cestrum nocturnum extract in an in-vivo cat model

Muscle relaxants are an irreplaceable item within the modern surgical toolkit. Their almost universal use during surgical procedures of medium-to-long duration means that it is essential that all anesthesiologists must have a comprehensive knowledge of their history and the future prospects for their continued evolution. There are a number of naturally- occurring acetylcholinesterase and butrylcholinesterase inhibitors, including the solanaceous glycoalkaloids (SGAs), which are found in the plants of the family Solanaceae. In the Pharmacopiea of the Philippines indigenous plants, one such plants is Cestrum nocturnum (Dama de Noche). Objective: This experimental animal study was therefore undertaken to determine the neuromuscular effect of the intravenous administered Cestrun nocturnum in an anesthesixed cat. Methods: An N-of-1 A-B-A design in in vivo study was undertaken compairing the effect of the Cestrun Nocturnum ansd atracurium on the neuromuscular junction of an anesthesized cat. Results: Intravenously administered cestrum nocturnum produced an incomplete (40% TOF) but sustained depolarization of the neuromuscular junction that took an hour to fully recover. It also prolonged the onset of atracurium- induced paralysis and delayed its recovey in the pesence of neostigmine. Conclusion: In the light of these findings, we infer that cestrum nocturnum interact with atracurium and neostigmne possibly through pharmacokinetic and pharmacodynamic mechanisms. Further studies are recommended to elucidate these mechanisms.