Prader-Willi Syndrome: A case report / 대한마취과학회지

In 1956, Prader and Willi first described a clinical syndrome that included severe neonatal hypotonia, hyperphagia, obesity, diabetes, hypogonadism, cryptorchidism, dental caries and mental deficiency. We have anesthetized a male patient who had Prader-Willi syndrome. He suffered for both pyoknee. General anesthesia was performed using N2O-O2-isoflurane. During induction and maintenance of anesthesia, we focused on the airway management, hypotonia, abnormal glucose metabolism, protection of aspiration and cardiovascular stabilization. Emergence of anesthesia was unremarkable. But he was expired from sepsis on the fourth postoperative day.

Rocuronium Pretreatment for Prevention of Myalgia Following Succinylcholine Administration / 대한마취과학회지

BACKGROUND: The purpose of this study was to assess the effect of rocuronium pretreatment on the succinylcholine induced biochemical changes and fasciculations, myalgia and to compare it with vecuronium pretreatment. METHODS: We have studied 60 patients undergoing minor elective surgery, in a prospective double blinded method. Three groups of 20 patients each were pretreated with saline 0.01 ml/kg (group C), rocuronium 0.05 mg/kg (group R), or vecuronium 0.007 mg/kg (group V). Three minutes after the pretreatment, 1.5 mg/kg succinylcholine was injected. Serum potassium five minutes after succinylcholine and creatine kinase 24 hr after operation were measured. Fasciculations and postoperative myalgia at 24 and 48 h were evaluated. RESULTS: The increase in creatine kinase and incidence of fasciculations were lowest in the rocuronium group (33 IU/L; 15%) and followed by vecuronium group (58 IU/L; 50%) and highest in the control group (101 IU/L; 100%). The increase in serum potassium concentration (0.3 mEq/L) was not attenuated by any regimen. The incidence of postoperative myalgia on day 1 and day 2 was lower in the rocuronium (40%, 30%) and the vecuronium (50%; 35%) group than control group (85%; 75%). CONCLUSIONS: Rocuronium pretreatment is more effective in reducing creatine kinase rise and fasciculations after succinylcholine than vecuronium. However rocuronium and vecuronium are also effective in preventing postoperative myalgia.

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).

Influence of Various Muscle Relaxants on the Plasma Cholinesterase Activity / 대한마취과학회지

BACKGROUND: The reduction in the plasma cholinesterase (PChE) level results in slow to hydrolysis of succinylcholine (SCC) and mivacurium (MIV). The factors altering the level of the normal enzyme in human could be considered under the several conditions. We investigated in the present study whether the drugs induced decreases in normal PChE activity after administration of various muscle relaxants during anesthesia are evident and how these results should be influenced to the time course of neuromuscular blockade produced by SCC and MIV. METHODS: Young adult patients of ASA class I or II scheduled for elective surgery requiring muscle relaxation were premedicated and anesthesia was maintained with nitrous oxide in oxygen with increment of thiopentone or fentanyl as required. In the neuromuscular monitoring, surface electrodes were applied on the ulnar nerve at wrist. Supramaximal transcutaneous single twitch stimulation (1 Hz) during onset and 0.1 Hz during recovery of neuromuscular blockade induced by various muscle relaxants delivered by a peripheral nerve stimulator was applied. Twitch response of thumb adductor was measured mechanomyographically using 2 kg Load Cell Strain Gauge with thumb piece modification. Recordings were made on a Gould recorder. PChE levels were measured by the modified Garry method after induction of anesthesia and, at 3, 10, 20 and 30 min following administration of 2 x ED95 of pancuronium (PAN), vecuronium (VEC) and atracurium (ATR). Neuromuscular recordings were measured with onset time defined as lag time and manifest time, and recovery time defined as clinical duration, recovery index and total duration. RESULTS: The levels of PChE were significantly reduced after administration of PAN and VEC (p<0.05). Onset times were significantly shorten but recovery time in the group given MIV pretreated by small dose of PAN was significantly prolonged (p<0.05). And there were a evidence to prolong recovery time in the group pretreated by small dose of VEC but not significant. CONCLUSIONS: It is concluded that aminosteroidal derivative neuromuscular blocking agents have presumably evidence induced decreases in PChE activity rather than benzylisoquinolinium derivative neuromuscular blocking agents.

Comparison of Effects of Propofol-Succinylcholine and Thiopentone-Succinylcholine on the Serum Potassium / 대한마취과학회지

BACKGROUND: The aim of this study was to compare the effect of propofol with succinylcholine and thiopentone with succinylcholine on serum potassium concentration during induction of general anesthesia. METHODS: Forty patients scheduled for elective surgery were allocated at random into two groups, one to receive propofol with succinylcholine or other to receive thiopentone with succinylcholine. We measured serum potassium concentration at preinjection and at 1, 5 and 10 minutes after injection of propofol with succinylcholine or thiopentone with succinylcholine respectively. RESULTS: There was significant increase in the serum potassium concentrations at 1, 5 and 10 minutes after injection of propofol-succinylcholine and thiopentone-succinylcholine compared with those before injection in two groups. No significant difference in serum potassium concentrations was observed between the two groups. CONCLUSIONS: The changes in serum potassium due to injection of propofol and succinycholine were very similar to those found during injection of anesthesia with thiopentone and succinylcholine. It was reassuring that such small changes of serum potassium occur when propofol-succinycholine and thiopentone-succinylcholine were used and that these changes within normal ranges were unlikely to be of clinical significance.

Hyperkalemia Following Succinylcholine Administration in Elderly Patient with Chronic Hypokalemia: A case report / 대한마취과학회지

Acute hyperkalemia may result from excessive load, transcellular shift, decreased renal excretion and so on. Potassium release following succinylcholine administration is sufficient to cause ventricular dysrrhythmia and cardiac arrest in some conditions such as severe burn, massive trauma, spinal cord injury, some neuromuscular disease, and cerebral damage. We experienced a case of acute hyperkalemia associated with cardiac arrythmia immediately after administration of succinylcholine in a 80 year-old male patient who was diagnosed as spondylitis tuberculosa and psoas abscess. The hyperkalemia was attenuated by calcium chloride and sodium bicarbonate and cardiovascular instability was treated by vasoactive drugs symptomatically. Though the eldery patient with diabetes mellitus had been shown chronic hypokalemia, we should be aware of occurrence of sudden hyperkalemia after administration of succinylcholine.

Prolonged Apnea after Cesarean Section in Patient with Low Level of Plasma Cholinesterase Activity: A case report / 대한마취과학회지

Succinylcholine-induced prolonged neuromuscular blockade may occur in patients with either a low level of plasma cholinesterase activity or genotypically abnormal form of that enzyme. We experienced a case of succinylcholine-induced prolonged apnea due to a low level of plasma cholinesterase activity. A 31-year-old woman, full term primigravida, underwent cesarean section for breech presentation under general anesthesia. Familial and past medical history were nonspecific and preoperative physical and laboratory findings were within normal range. After operation, delayed apnea was detected and lasted for about one hour. We performed controlled and assisted ventilation for two and half hours. Plasma cholinesterase activity measured 30.00 IU/L (colorimetric method, normal value: 1130~1960 IU/L) at the first postoperative day. She was discharged on 7th postoperative day without any sequelae. From follow-up study after six months, it measured 1.02 U/ml (EIA, normal value: 7~9 U/ml).

Right Cognition of Succinylcholine / 대한마취과학회지

Non-depolarizing muscle relaxant; d-tubocurarine was introduced clinically in 1942. Thereafter depolarizing muscle relaxant; succinylcholine was introduced in 1951. Those muscle relaxants were highly contributed in modern anesthesia practice today. But, since many years ago complications of succinylcholine were reported clearly so many anesthesia practice. Complications were such as ventricular arrythmia(cardiac arrest), fasciculation, hyperkalemia, muscle pain, elevation of intragastric, intraocular & intracranial pressure, prolonged apnea, generalized muscle clonus, masseter muscle rigidity and malignant hyperthermia etc. Succinylcholine was still used in clinical practice despite of many complications reported as long as more than 45 years. Finally, FDA(USA) decleared the routine use of succinylcholine was contraindicated in children and adolescents. Many textbooks of anesthesiology shows that use of succinylcholine was contraindicated in children and adolescents those were published recently since 1994. What is the current status of succinylcholine in despite of changing current concept of succinylcholine use in Korea? Succinylcholine is still inadvertently used in Korea over 79% of resident training hospital. Intravenous dantrolene reserve was only one hospital(1.4%). Undoubtedly, amazing things were going on in Korea. Seventeen cases of malignant hyperthermia had been reported from 1971 to 1996 on Korean medical journals. It's mortality was 70.6%. Not only the reported malignant hyperthermia, there are many cardiac arrest during anesthesia reported on Korean medical journals. Etiological analysis of cardiac arrest was reviewed some of them, there are certain numbers of cardiac arrest cases confirmed by succinylcholine was guilty. What is the counterplan? Change the current concept of succinylcholine is important. Conclusions ; 1. Non-depolarizing mucle relaxant should be used for intubation &/or muscle relaxation. 2. Hot line for malignant hyperthermia should be established.. 3. Intravenous dantrolene reserve is necessary. 4. Routine monitoring during anesthesia should be blood pressure, ECG, SPO2, ETCO2, body temperature and peripheral nerve stimulator.

Cardiac Asystole Following a Single Dose of Succinylcholine: A case report / 대한마취과학회지

A 28-yr-old woman, weighing 61 kg with bleeding myoma of uterus was scheduled for total abdominal hysterectomy. There was no history of cardiac arrhythmia or syncope. She was not premedicated. The heart rate was 115 beats/min and arterial pressure was 155/95 mmHg, immediately before the induction of anesthesia. Under the preoxygenation, anesthesia was induced with IV injection of thiopental sodium 250 mg followed by succinylcholine 75 mg. About 20 seconds after the succinylcholine bolus, the ECG showed an abrupt change from sinus rhythm to asystole without any stimulus including laryngoscopy. After a precordial thump and atropine 0.5 mg IV, tracheal intubation and ventilation with 100% O2 were quickly accomplished. Normal sinus rhythm with heart rate of 87 beats/min returned during laryngoscopy and intubation. The interval from the sinus arrest to the reestablishment of normal sinus rhythm was only 15 seconds. Surgery proceeded uneventfully and the patient recovered without any complication.