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Background@#Perioperative anaphylaxis is a life-threatening clinical condition characterized by severe respiratory and cardiovascular manifestations. Neuromuscular blocking agents are the most common cause of anaphylaxis during anesthesia. Case: We report a case of rocuronium-induced anaphylaxis treated with sugammadex. A 75–year-old woman was scheduled to undergo spinal surgery. She had no history of allergies. After the injection of rocuronium, she developed hypotension and tachycardia, and skin rashes and urticaria appeared. The patient received sugammadex to delay the operation, and her vital signs were stabilized. On the 76th postoperative day, we performed intradermal tests for rocuronium, propofol, and cefazolin. Diluted rocuronium alone induced 14 mm of flare and 8 mm of wheal within 5 min, both of which disappeared within 15 min after the intradermal injection. @*Conclusions@#Sugammadex is a useful rocuronium antagonist that can be used to treat rocuronium-induced anaphylaxis.
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Background@#The OptiscopeTM and the backward, upward, rightward pressure (BURP) maneuver are widely used in clinical practice because the BURP maneuver facilitates intubation by improving visualization of the larynx. However, the effect of the BURP maneuver is unclear when using the OptiscopeTM. Therefore, we retrospectively investigated the effect of the BURP maneuver on intubation using the OptiscopeTM. @*Methods@#Sixty-eight patients intubated with the OptiscopeTM were enrolled. We used the BURP maneuver in Group A (n = 33) and the conventional maneuver (which does not use the BURP maneuver) in Group B (n = 35). BURP application status was a binary variable representing whether the BURP maneuver was used during the intubation. A multiple linear regression analysis was performed to assess the effects of the BURP application status on intubation time controlling for body mass index, preoperative dental injury status, obstructive sleep apnea history, thyromental distance, sternomental distance (SMD), interincisor distance, history of neck rotation restriction, and Mallampati classification. @*Results@#There was no difference in the intubation time between the two groups. According to the regression model (R2 = 0.308, P = 0.007), the BURP maneuver (Group A) decreased the intubation time by 6.089 seconds (95% confidence interval 1.303–10.875, P = 0.014) compared to Group B. @*Conclusion@#The BURP maneuver reduced intubation time when using the OptiscopeTM.
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Although intracranial hemorrhage from arteriovenous malformation (AVM) during pregnancy is rare, it can have fatal consequences. Anesthetic techniques for these patients should ensure precise hemodynamic control, and the goals of anesthesia should include both fetal and maternal well-being. We report a case of anesthetic management for cesarean section in a 31-year-old woman who presented at 32 weeks gestation with an acute intracranial hemorrhage secondary to rupture of a previously diagnosed AVM. Our medical team decided to perform emergent cesarean section under regional anesthesia before transferring the patient to the neurosurgical intensive care unit for further monitoring and appropriate postoperative pain control. The patient was alert and cooperative during neuraxial anesthesia. The operation was successful, and the patient showed gradual improvement in neurosurgical status after several days. We concluded that in case of emergency, regional anesthesia can be a safe strategy for cesarean section in a pregnant woman with symptomatic AVM.