Relationship between first-twitch depression and train-of-four ratio during sugammadex reversal of rocuronium-induced neuromuscular blockade / 대한마취과학회지

BACKGROUND: The primary outcome of sugammadex reversal for rocuronium-induced neuromuscular block (NMB) is a train-of-four ratio (TOFR) of 0.9, not first twitch (T1) height. We investigated whether the recovery of TOFR or T1 differs based on the reversal of NMB with neostigmine or sugammadex. METHODS: The acceleromyographic responses from 0.6 mg/kg of rocuronium were monitored supramaximally in 80 patients after induction of anesthesia. The TOFR and T1 height were recorded, and saved in a personal computer using TOF-Watch SX Monitor software in all patients. Patients were randomly assigned to 2 groups to receive either neostigmine 50 µg/kg with glycopyrrolate 10 µg/kg (neostigmine group, n = 40) or sugammadex 2.0 mg/kg (sugammadex group, n = 40). The primary objective was to determine the difference of recovery time between TOFR to 0.9 and T1 to 0.9 after sugammadex or neostigmine administration during moderate rocuronium-induced NMB. RESULTS: The recovery pattern of the TOFR 2 min after sugammadex administration was 1.0 or more, but that of T1 was less than 90% (T1 / control value) up to 6 min after drug was injected. The recovery pattern of TOFR and T1 was similar during the 20 min after reversal with neostigmine. CONCLUSIONS: If you have not performed the T1 monitoring, both TOFR and T1 should be considered to confirm suitable recovery during the 6 min after reversal with sugammadex during rocuronium-induced moderate NMB.

Anaphylactic shock caused by an intradermal skin test-negative antibiotic during general anesthesia: A case report

Anaphylaxis during the perioperative period is rare, but it still causes severe cardiovascular and respiratory collapse that can be fatal. In particular, when using antibiotics that have a high risk of hypersensitivity reactions, it is important to establish that intradermal skin tests are negative before using antibiotics. We report a case of anaphylactic shock occurring during general anesthesia after using an intradermal skin test-negative antibiotic. Regrettably, negative results of intradermal skin tests before using antibiotics do not completely eliminate the risk of anaphylaxis. Therefore, anesthesiologists should be prepared for anaphylaxis to occur at any point during the perioperative period.

Postoperative nausea and vomiting after capsicum plaster at the P6 acupoint after laparoscopic cholecystectomy according to gender

BACKGROUND: Postoperative nausea and vomiting (PONV) has a remarkably high reported incidence (70%) in female patients after anesthesia. This study aims to evaluate the clinical effect of capsicum plaster at the P6 acupoint with respect to gender in preventing PONV after laparoscopic cholecystectomy. METHODS: A prospective, placebo-controlled, double-blind study was conducted with 120 patients undergoing laparoscopic cholecystectomy and who were randomly assigned to four groups (n = 30 each): Group MC = male patients with capsicum plaster at the P6 acupoint; Group MP = male patients with placebo tape at the P6 acupoint; Group FC = female patients with capsicum plaster at the P6 acupoint; Group FP = female patients with placebo tape at the P6 acupoint. The treatment tape was applied before the induction of anesthesia and was removed eight hours after the operation. RESULTS: The incidence of nausea was reduced in both genders with application of capsicum plaster at P6 acupoint. No change in vomiting or use of anti-emetics was observed. Satisfaction scores with PONV control were improved with this intervention. No gender difference was observed which actually the initial objective of this study was. CONCLUSIONS: The application of capsicum plaster at the P6 acupoint is a proven antiemetic method in both gender after laparoscopic cholecystectomy, however there are no intergender differences.