Anesthetic management for ascending aorta replacement in a patient who refused autologous transfusion for religious reasons.

We report on the anesthetic management of a 69-year-old female Jehovah's Witness undergoing cardiopulmonary bypass to replace the ascending aorta; the patient refused transfusion of stored autologous or allogeneic blood products for religious reasons. The strategy involved preoperative hematopoiesis with recombinant human erythropoietin and iron, intraoperative acute normovolemic hemodilution, the use of a cell-saver system, administration of high-dose tranexamic acid, controlled hypotension, avoidance of low body temperature, simplification of the surgery, and lower blood dilution during cardiopulmonary bypass.

Visual evaluation of fade in response to facial nerve stimulation at the eyelid.

STUDY OBJECTIVE: The aim of this study is to investigate the probability of visual detection of fade in response to train-of-four (TOF) stimulation, double-burst stimulation3,3 (DBS(3,3)), or DBS(3,2) at the eyelid in comparison to that at the thumb. DESIGN: This is a randomized single-blinded study. SETTING: The study took place at the University hospital. PATIENTS AND MEASUREMENTS: Sixty adult patients underwent general anesthesia. INTERVENTIONS AND MEASUREMENTS: Patients were randomly divided into either the eyelid group (n = 30) or the thumb group (n = 30). In the eyelid group, at the varying degrees of neuromuscular block caused by vecuronium, TOF, DBS(3,3), or DBS(3,2) were given at the temporal branch of the facial nerve, and the probability of visual detection of fade in response to TOF, DBS(3,3), or DBS(3,2) was determined at the eyelid. Similarly, in the thumb group, the probability of visual detection of fade in response to TOF, DBS(3,3), or DBS(3,2) was examined at the thumb. MAIN RESULTS: When the true TOF ratios were 0 to 0.60, the probability of detection of TOF fade in the eyelid group was significantly lower than in the thumb group (P < .05). At the true TOF ratios of 0.31 to 0.70, the probability of visual detection of DBS(3,3) fade in the eyelid group was significantly less than in the thumb group (P < .05). When the true TOF ratios were 0.81 to 1.00, the probability of detection of DBS(3,2) fade in the eyelid group was significantly higher than in the thumb group (P < .05). CONCLUSION: The probability of visual detection of fade in response to TOF or DBS(3,3) is lower at the eyelid than the thumb. In contrast, DBS(3,2) fade tends to be seen more frequently at the eyelid than at the thumb.

Delayed recovery of vecuronium neuromuscular block in diabetic patients during sevoflurane anesthesia.

PURPOSE: To study recovery from vecuronium-induced neuromuscular block in diabetic patients during total iv or sevoflurane anesthesia. METHODS: 30 diabetic patients were assigned to diabetes mellitus (DM)-total iv anesthesia (TIVA); (n = 15) or DM-sevoflurane (S) groups (n = 15). Thirty healthy patients were divided into control-TIVA (n = 15) or control-S groups (n = 15). In the DM-TIVA or control-TIVA groups and DM-S or control-S groups, anesthesia was maintained with propofol and fentanyl, and nitrous oxide-oxygen-sevoflurane 1.7%, respectively. After receiving vecuronium 0.1 mg.kg(-1)iv, recovery of the train-of-four (TOF) was compared among the four groups. RESULTS: Times to the return of T2, T3, or T4 in the DM-TIVA and DM-S groups were longer than in the control-TIVA and control-S groups (46.9 +/- 13.8 vs 32.2 +/- 10.7 and 32.6 +/- 8.7 min for T2, P < 0.05). T1/control in the DM-S group was less than in the control-TIVA and DM-TIVA groups 50 to 120 and 70 to 120 min after receiving vecuronium, respectively (P < 0.05). T1/control in the control-S group was less than in the control-TIVA group 80 to 120 min after receiving vecuronium (P < 0.05). TOF ratio in the DM-S group was less than in the control-TIVA, DM-TIVA, and control-S groups, 60 to 120, 80 to 120, and 80 to 120 min after receiving vecuronium, respectively (P < 0.05). CONCLUSION: In diabetic patients receiving vecuronium, recovery of T1/control and TOF ratio are delayed during sevoflurane anesthesia, but not in association with total iv anesthesia.