ABSTRACT
Perioperative hypothermia can occur frequently and lead to various complications. Laparoscopic procedures do not require a large incision or exposure of the viscera, but a prolonged and high pressure procedure can lead to unexpected hypothermia. Hypothermia prolongs the time-course of non-depolarizing neuromuscular blocking agents by reducing the plasma clearance significantly. Rocuronium, a new aminosteroidal neuromuscular blocking agent, can be influenced by reductions in plasma clearance and prolong the duration of action. Therefore, patients must receive ventilator care in the ICU. Aggressive measures were taken for hypothermia, and the patient was discharged without any complications. We report a case of delayed of neuromuscular blockade by rocuronium in a hypothermic patient during a laparoscopic procedure with a brief review of literatures.
Subject(s)
Humans , Androstanols , Hypothermia , Laparoscopy , Neuromuscular Blockade , Neuromuscular Blocking Agents , Plasma , Ventilators, Mechanical , VisceraABSTRACT
Frozen shoulder is characterized by pain in the shoulder and limitation of glenohumeral movement. The underlying pathologic changes in frozen shoulder are synovial inflammation with subsequent reactive capsular fibrosis. Capsular fibrosis is the ultimate course of frozen shoulder suffering from various causes irrespectively. Therefore, adhesions that are affecting the joint movement must be released. Most important diagnostic method is thoughtful history taking and physical examination, and ultrasonography is very valuable device of diagnosis and treatment. Interventional microadhesiolysis and nerve stimulation (IMNS) is effective to manage frozen shoulder patients. IMNS for frozen shoulder is composed of three release approaches. These are (1) subacromial, (2) posterior inferior capsular, and (3) subdeltoidal & subcoracoidal release and round needle can be used for each release. We report this experiences and recommand this technique for the treatment of frozen shoulder patients.