The Neuromuscular Effects of Succinylcholine, Mivacurium and Vecuronium Corresponding to the Blood Flow Occlusion of Time in the Isolated Forearm / 대한마취과학회지

BACKGREOUND: The magnitude of neuromuscular blockade is related to plasma concentration of muscle relaxants. This study was designed to compare the maximal depression of twitch height by blood flow occlusion using a tourniquet at various time interval after intravenous administration of muscle relaxants. METHOD: We studied 127 healthy male adult patients who underwent elective surgery under the general anesthesia with propofol infusion and 50% nitrous oxide. The single supramaximal twitch stimulation applied to the ulnar nerve at the wrist at 1 Hz. The twitch response of adductor pollicis muscles were measured by a 2 kg Load Cell strain gauge with a thumb piece modification and recorded by a Gould TA 240 recorder. After occlusion of blood flow by the tourniquet in the upper arm, in which the neuromuscular monitoring was applied on the wrist, we administered the equipotent dose (ED95) of succinylcholine (S group), mivacurium (M group), and vecuronium (V group) intravenously on the contralateral arm respectively. We measured the maximal depression (%) of twitch height after the releasing tourniquet at 30, 60, 90, 120, 150, and 240 second intervals after the injection of each drug. RESULTS: The depression of twitch height was not found from 90 seconds of tourniquet time in the M group, and 120 seconds of tourniquet time in the S group. However, in the V group, the depression of twitch height was maintained to 240 seconds of tourniquet time. CONCLUSIONS: It is suggested that the plasma concentration of mivacurium declined faster than that of succinylcholine, and that of vecuronium decreased slowest among the groups after intravenous administration of equipotent dose (ED95).

Detection of Lumbar Disc Herniation after General Anesthesia: A case report / 대한마취과학회지

Reports of neural and non-neural injury associated with anesthesia have appeared in the medical literature. The majority of these injuries were due to improper patient positioning on the operating table and mostly correlated with the duration of surgery. We observed a case of lumbar disc herniation that was detected after general anesthesia in the traditional supine position. A 34-year-old woman underwent an operation for removal of uterine myoma. She complained of newly developed severe back pain that radiated down the lower right leg. HIVD L4~5 confirmed by lumbar MRI at POD 4th. We felt the cause of HIVD was related to the supine position or preexisting back pain with HIVD was exacerbated during surgery. This is possible to be prevented by evaluating the patient's postural limitation during the visit before anesthesia, padding under lumbar area and a more appropriate position to suit the patient needs for example, Lawn-chair position. The patient was treated with epidural injection of steroid at pain clinic.

Detection of Lumbar Disc Herniation after General Anesthesia: A case report / 대한마취과학회지

Reports of neural and non-neural injury associated with anesthesia have appeared in the medical literature. The majority of these injuries were due to improper patient positioning on the operating table and mostly correlated with the duration of surgery. We observed a case of lumbar disc herniation that was detected after general anesthesia in the traditional supine position. A 34-year-old woman underwent an operation for removal of uterine myoma. She complained of newly developed severe back pain that radiated down the lower right leg. HIVD L4~5 confirmed by lumbar MRI at POD 4th. We felt the cause of HIVD was related to the supine position or preexisting back pain with HIVD was exacerbated during surgery. This is possible to be prevented by evaluating the patient's postural limitation during the visit before anesthesia, padding under lumbar area and a more appropriate position to suit the patient needs for example, Lawn-chair position. The patient was treated with epidural injection of steroid at pain clinic.