Effect of sugammadex or neostigmine neuromuscular block reversal on bispectral index monitoring of propofol/remifentanil anaesthesia.

BACKGROUND: Sugammadex is a modified γ-cyclodextrin with a novel mechanism of action for reversing the steroidal neuromuscular blocking agent rocuronium. Bispectral index (BIS) is an EEG-derived measure which can be sensitive to frontal electromyographic (EMG) artifacts. We compared BIS values before and after sugammadex or neostigmine neuromuscular block (NMB) reversal in patients with or without high EMG activity. METHODS: During stable propofol/remifentanil anaesthesia and rocuronium-induced block, 48 patients were randomly allocated to receive sugammadex 4 mg kg(-1) or neostigmine 50 µg kg(-1)/glycopyrrolate 10 µg kg(-1), 10 min after the end of surgery. RESULTS: Five minutes after sugammadex administration, mean BIS 50.1 (10.3) increased (P=0.018) to 61.7 (7.9) in 11 patients with high EMG activity. In contrast, BIS 49.3 (4.9) remained at 51.9 (5.4) in 13 patients who had no EMG activity. Fifteen minutes after neostigmine administration, mean BIS 51.9 (8.1) increased (P=0.007) to 63.9 (8.1) in 13 patients who had reappearance of muscle activity. However, in 11 patients who had no EMG activity, BIS 52.3 (7.4) remained at 53.3 (6.8). There was no significant difference between the sugammadex and neostigmine groups over time. CONCLUSIONS: We have shown that reversal of NMB with sugammadex or neostigmine increased BIS values dependent on the presence of EMG activity. Thus, the effect of muscle activity reappearance during rocuronium NMB reversal spuriously increasing the BIS value should be taken into consideration when relying on BIS monitoring for evaluating propofol/remifentanil recovery.

Comparison of a new neuromuscular transmission monitor compressomyograph with mechanomyograph.

BACKGROUND: We developed a new neuromuscular transmission monitor, the compressomyograph (CMG, European patent number: EP 06018557.6, US patent number: US 60/824.541). This is the first preliminary report comparing neuromuscular block monitored by CMG and the Relaxometer mechanomyograph (MMG). METHODS: The two monitors were randomly allocated to the left or right hands of 16 patients. T1, first twitch of the train-of-four (TOF) expressed as percentage of control response, and the TOF ratio (T4:t1) were used to evaluate the neuromuscular block produced by rocuronium 0.6 mg kg(-1). RESULTS: The CMG monitor exhibited no pre-relaxation reverse fade (T4>T1) or T1 exceeding 100%. There was no significant difference in mean (SD) onset time, Dur(25) (time to T1 25% recovery), or Dur(0.9) (time to 0.9 TOF ratio recovery) measured by the CMG [2.4 (0.9), 22.6 (4.1), 43.1 (10.3) min, respectively] compared with MMG [2.1 (0.9), 22.9 (3.3), 43.3 (10.0) min, respectively]. According to Bland and Altman analysis, the bias (upper and lower limits of agreement) for T1% was -0.3% (+13.4% and -13.8%) and for TOF ratio was -0.009 (+0.068 and -0.085). CMG showed 100% sensitivity and 75% specificity in indicating full relaxation for tracheal intubation, and 80% sensitivity with 86% specificity in predicting MMG 0.9 TOF ratio. CONCLUSIONS: The CMG could be a reliable clinical monitor in the daily anaesthesia practice that does not require time to set up or rigid support of the arm.

[Identification of health endangering substances in air pollution]. / Zur Feststellung von gesundheitsgefährdenden Belastungen durch Luftverunreinigungen.

In a health-related evaluation of the environment, timely recognition of possible health hazards is of much greater significance than describing health injuries that have already occurred. The following model has been found to be workable: The entire study consists of 4 parts which are quite significant when compared with each other and analyzed statistically. (1) Detailed interviews with physicians in practice in the area examined (2) Spirometric tests among school children in third and fourth grades (elementary school) (3) Questionnaires to be completed by the parents of the school children examined, in which the questions implied in (1) are also included. (4) The results obtained are compared to the available data pertaining to the air quality in the region. Possible exposure to adverse indoor conditions in schools and homes are also taken into consideration.

[Pollution of drinking water by tetrachloroethylene]. / Trinkwasserverunreinigung durch Tetrachlorethylen.

At the end of the year 1983 and at the beginning of 1984, groundwater contamination with tetrachloroethylene was discovered south of Graz. Many wells showed an elevated concentration of tetrachloroethylene. 1210 persons living in this area were examined. As tetrachloroethylene may cause liver damage, screening tests were carried out in order to detect pathological liver function tests (LFT), such as gamma-GT elevation. In most cases, initially elevated LFT could be attributed to alcohol abuse. After thorough medical examinations, two cases remained unclear; later on, however, the initially elevated LFT could no longer be detected. This is a certain indication that there was some type of stress on the liver shortly before the blood sample was taken. In all other cases of liver disease, the causes could be determined. The pollution of drinking water was not the cause of pathological LFT. Nevertheless, the inhabitants of this region will receive drinking water from the public water supply for safety reasons. However, one thing that needs to be stated very clearly is that these findings which fortunately show no detrimental effect due to the pollution of drinking water, do not allow any conclusions concerning the possibility of injury to health, i.e. they do not preclude possible impairment of health as a consequence of prolonged consumption of the polluted drinking water.