Comparing Neuromuscular Blockade Measurement Between Upper Arm (TOF Cuff®) and Eyelid (TOF Scan®) Using Mivacurium during General Anesthesia.

BACKGROUND Mivacurium is a non-depolarizing neuromuscular blocking agent. TOF-Cuff® is a device that monitors intraoperative neuromuscular blockade and blood pressure. TOF-Scan® measures muscle relaxation status of an anaesthetized patient. This study included 36 patients aged 18 to 75 years presenting for elective surgery, to compare neuromuscular blockade measured using the TOF-Cuff of the upper arm and the TOF-Scan of the facial corrugator supercilii muscle during general anesthesia and following administration of mivacurium. MATERIAL AND METHODS Train-of-four (TOF) values were obtained every 30 s before intubation and successively every 5 min until extubation. RESULTS The median onset time for TOF-Cuff was longer than for TOF-Scan (210 s vs 90 s, P<0.00001). Multiplying the time to relaxation (according to TOF-Scan) by 1 to 8, respectively, provided concordance with the TOF-Cuff result for the following cumulative percentages of patients: 5.5%, 38.9%, 58.3%, 77.8%, 83.3%, 86.1%, 88.9%, and 91.7%. Analogue values for time to recovery from the last dose were 11.1%, 63.9%, 83.3%, 86.1%, 86.1%, 88.9%, 88.9%, and 91.7%. The proportion of patients who still had TOFratio=0 in the assessment performed at min 15 did not differ significantly between these 2 methods (P=0.088). Both TOF-Scan and TOF-Cuff showed a false-negative result in patients with clinical symptoms of preterm recovery; the numerical difference favored TOF-Cuff (1.6% vs 2.1%) but without statistical significance (P=0.2235). CONCLUSIONS When measurement on the limb is not possible, TOF-Scan on the eyelid can be an alternative for TOF-Cuff on the upper arm, if the time to relaxation is multiplied by at least 8, which is enough for 90% of patients.

A Review of the Current Status of Anesthetic Management of Patients with Rheumatoid Arthritis.

Rheumatoid arthritis (RA) is a chronic connective tissue disease of immunological etiology. In the course of the disease, symptoms of the musculoskeletal system predominate, but other systems can also be affected. The disease may require long-term treatment, and patients often require surgery on damaged joints. Complications of the disease and drug interactions may contribute to difficulties in perioperative care; therefore, knowledge is required to provide appropriate care. When anesthetizing a patient with RA, we should pay special attention to preoperative evaluation, taking a medical history, risk of difficult intubation or cardiac incidents, respiratory insufficiency, and frequent pulmonary infections. It is important to be aware of perioperative glucocorticoids supplementation, especially in patients with suspected adrenal insufficiency. Postoperative management, such as pain management, early rehabilitation, and restart of pharmacotherapy play, an important role in the patient's recovery. Special attention should be paid to perioperative management in pregnant women, as the disease is a significant risk factor for complications, and some anesthetic procedures can be noxious to the fetus. Due to the nature of the disease, it can be challenging for the anesthesiologist to provide good and appropriate pain medications, symptom management, and other necessary techniques that are done to anesthetize the patient properly. This work is based on the available literature and the authors' experience. This article aims to review the current status of anesthetic management of patients with rheumatoid arthritis.

To Be a Pregnant Surgeon-Is There Anything to Be Afraid of?

BACKGROUND: Women who decide to become a surgeon are afraid of motherhood. The aim of this study was to establish the opinions of patients and doctors on the professional activity of pregnant surgeons (PS). METHODS: The study was conducted on a group of respondents consisting of doctors and patients. The study was carried out using a questionnaire of 12 questions. RESULTS: 1074 doctors and 657 patients responded to the survey. Doctors, especially non-surgeons, significantly more often believed that PS should stop working in the operating theatre immediately after pregnancy confirmation. Most patients thought that operations performed by PS are normal, whereas the doctors more often considered it heroic or irresponsible. Doctors more often mentioned fear of financial stability and fear of losing their reputation as reasons for working by PS. Most respondents claimed that it made no difference whether they were operated on by PS or not. However, patients significantly more often declared their willingness to be operated on by PS. CONCLUSIONS: The study showed that female surgeons may have slight concerns about how they will be perceived by colleagues and patients. However, most respondents, patients significantly more often, believed that working during pregnancy is the natural course of things.

The Incidence of Gastrointestinal Stromal Tumors in Obese Patients-A Large Single Center Experience.

Background and Objectives: Gastrointestinal stromal tumors (GISTs) are rare mesenchymal neoplasms located mainly in the fundus (60-70%). The incidence of GIST is approximately 10 per million population per year in Europe, with a peak incidence at the age of 63. Recent studies suggest that morbidly obese patients have a higher incidence of GIST than the general population. The aim of this study was to analyze the incidence of GIST in patients undergoing laparoscopic sleeve gastrectomy (LSG) in our department. Materials and Methods: this paper present the retrospective study of prospectively collected data of 1564 patients who underwent LSG in a single large bariatric center from October 2013 to September 2021. After surgery, each sample of the resected stomach was sent for histopathological examination. For the analysis, we included patients diagnosed with GIST intraoperatively or postoperatively. Results: GISTs were found in five patients (0.31%). There were three men and two women. The mean age was 50.2 (range 32-63 ± 11.8) and the mean preoperative body mass index was 43.3 kg/m2 (40-49.4 ± 3.2). In four cases, GISTs were found in the fundus (80%), and in one in the pylorus (20%). None of the tumors were larger than 7 mm in diameter and all were diagnosed as a very low-risk category. No adjuvant treatment was required. All patients achieved good or satisfactory bariatric and metabolic results. Conclusions: The incidence of GIST in our study was estimated at 0.31%. All patients had a very low-risk GIST and no recurrence until follow-up. Recent literature suggests that the risk of GIST is higher in the obese population, and therefore surgeons should be aware of the risk of incidental GIST during LSG.