Comparison of clinical validation of acceleromyography and electromyography in children who were administered rocuronium during general anesthesia: a prospective double-blinded randomized study / 대한마취과학회지

BACKGROUND: Electromyography and acceleromyography are common neuromuscular monitoring devices. However, questions still remain regarding the use of acceleromyography in children. This study compared the calibration success rates and intubation conditions in children after obtaining the maximal blockade depending on each of the devices METHODS: Children, 3 to 6 years old, were randomly allocated to the TOF-Watch SX acceleromyography group or the NMT electromyography group. The induction was performed with propofol, fentanyl, and rocuronium. The bispectral index and 1 Hz single twitch were monitored during observation. The calibration of the each device was begun when the BIS dropped to 60. After successful calibration, rocuronium 0.6 mg/kg was injected. A tracheal intubation was performed when the twitch height suppressed to 0. The rocuronium onset time (time from administration to the maximal depression of twitch height) and intubating conditions were rated in a blinded manner. RESULTS: There was no difference in the calibration success rates between the two groups; and the calibration time in the electromyography group (16.7 +/- 11.0 seconds) was shorter than the acceleromyography group (28.1 +/- 13.4 seconds, P = 0.012). The rocuronium onset time of the electromyography group (73.6 +/- 18.9 seconds) was longer than the acceleromyography group (63.9 +/- 18.8 seconds, P = 0.042) and the intubation condition of the electromyography group (2.27 +/- 0.65) was better than the acceleromyography group (1.86 +/- 0.50, P = 0.007). CONCLUSIONS: Electromyography offers a better compromise than acceleromyography with respect to the duration of calibration process and surrogate for the optimal time of tracheal intubation in children.

Interictal Gastric Motility in Patients with Migraine

BACKGROUND: Nausea and vomiting are predominant accompanying symptoms of migraine attacks. Although the underlying mechanism is not yet clear, gastric stasis is assumed to be the main factor. However, few studies have used direct methods to establish delayed gastric emptying of migraine patients. We compared interictal gastric motility between migraine patients and normal controls with the aid of gastric scintigraphy. METHODS: The study population comprised patients who had been diagnosed with episodic migraine, according to the International Classification of Headache Disorders, edition II. The entire study population was completely free of gastrointestinal symptoms during the headache-free period. Gastric scintigraphy was performed to determine the time to half emptying (T 1/2) and the percentage of radioactive material remaining in the stomach (%RMR) at 30, 60, 90, and 120 min. RESULTS: Twenty-six migraine patients and 12 normal controls were recruited. The mean T 1/2 did not differ between the two groups (101.8 vs 95.2 min; p=0.432). The %RMR values in the stomach at 30, 60, 90, and 120 min also did not differ significantly between the two groups [87.5% vs 88% (p=0.900), 70.8% vs 71.2% (p=0.950), 54.2% vs 53.3% (p=0.753), and 39.0% vs 37.3% (p=0.583), respectively]. CONCLUSIONS: There is no gastric stasis in patients with episodic migraine during headache-free periods. Our results suggest that the main mechanism underlying the nausea and vomiting in migraine patients is not a gastric stasis in interictal periods, but rather a central process, as a result of changes occurring in the brainstem during acute migraine attacks.

Pseudohypoparathyroidism Presented With Seizure

Pseudohypoparathyroidism (PHP) is a rare clinical syndrome characterized by hypocalcemia, hyperphosphatemia and increase of serum parathyroid hormone in association with unique clinical features. We recently experienced a typical PHP type Ia patient who presented with recurrent seizure and muscle spasms and electroencephalogram (EEG) showed generalized spike-and-wave discharges. With the correction of hypocalcemia, seizures did not recur and epileptiform discharges disappeared. We suggest that the possibility of PHP should be considered in patients with seizures showing hypocalcemia and hyperphosphatemia.