Optimal anesthetic regimen for ambulatory laser microlaryngeal surgery.

OBJECTIVES/HYPOTHESIS: Laser microlaryngeal surgery (LMS) is a short operation requiring brief and intense paralysis. Adequate muscle relaxation and rapid recovery of neuromuscular function are essential for improving surgical conditions and reducing the incidence of complications during LMS. However, the ideal muscle relaxant with a rapid onset and short duration of action is not yet available. Rocuronium has rapid onset at higher doses, but with a prolonged duration of action. Sugammadex is a selective relaxant-binding agent that allows for rapid reversal of rocuronium-induced neuromuscular blockade. This study aimed to compare the surgical conditions and anesthesia time between two combinations of neuromuscular blocker and reversal agent, rocuronium-sugammadex (R-S) and succinylcholine-cisatracurium-pyridostigmine (S-C-P), and propose an optimal anesthetic regimen for improving the surgical conditions in LMS patients. STUDY DESIGN: Prospective, randomized, double-blinded clinical study. METHODS: Patients in the R-S group received 1 mg/kg rocuronium bromide, whereas those in the S-C-P group received 1 mg/kg succinylcholine. After endotracheal intubation, 0.08 mg/kg cisatracurium was injected in S-C-P patients. After the procedure, R-S patients received 2 mg/kg sugammedex, whereas S-C-P patients received 0.2 mg/kg pyridostigmine plus 10 µg/kg atropine. RESULTS: In the R-S group, surgical condition scores were significantly higher and anesthesia time was significantly shorter. The use of additive neuromuscular blocking agents was significantly higher in the S-C-P group. CONCLUSIONS: Muscle relaxation with rocuronium and reversal with sugammadex resulted in better surgical conditions and a shorter anesthesia time in patients undergoing LMS when compared to the S-C-P regimen. LEVEL OF EVIDENCE: 1b Laryngoscope, 127:1135-1139, 2017.

Effects of lipopolysaccharide on changes in red blood cells in a mice endotoxemia model.

The aim of this study was to evaluate changes in RBC aggregation and deformability over 24 hr and suggest specific shear stress values for detecting RBC deformability in a mouse endotoxemia model using lipopolysaccharide (LPS).Six-week-old male BALB/c mice received LPS (20 mg/kg) intraperitoneally. Aggregation indices (AIs) and T1/2 were measured to assess RBC aggregation, and elongation indices (EIs) were used to assess RBC deformability at shear stress values of 0.3, 0.5, 1, 3, 7, 10, 15 and 20 Pascals (Pa) 0, 30 min, 1, 2, 4, 6, 9, 12, 18 and 24 hours after the LPS injection.No significant differences were detected in the AIs during the study period, however, T1/2 shortened significantly 2, 6, 12, 18, and 24 hr after the LPS injection. The EIs increased significantly 24 hr after LPS injection at 0.5 and 1 Pa shear stress, whereas it decreased significantly at 10 Pa of shear stress 24 hr after the LPS injection.Altered RBC deformability was detectable 24 hr after the LPS injection and T1/2 may be a sensitive marker for detecting changes in RBC aggregation. The EIs should be measured at 1 Pa to detect changes in RBC deformability in LPS-induced septic mice.

Ultrasound-guided central cluster approach for the supraclavicular brachial plexus block: a case series.

There are many different approaches to ultrasound-guided supraclavicular brachial plexus block (US-SCBPB), and each has a different success rate and complications. The most commonly performed US-SCBPB is the corner pocket approach in which the needle is advanced very close to the subclavian artery and pleura. Therefore, it may be associated with a risk of subclavian artery puncture or pneumothorax. We advanced the needle into the central part of the neural cluster after penetrating the sheath of the brachial plexus in US-SCBPB. We refer to this new method as the "central cluster approach." In this approach, the needle does not have to advance close to the subclavian artery or pleura. The aim of this study was to evaluate the clinical outcomes of the central cluster approach in US-SCBPB.

Effect of nicardipine on renal function following robot-assisted laparoscopic radical prostatectomy in patients with pre-existing renal insufficiency.

OBJECTIVE: To investigate the renoprotective effect of nicardipine in patients with pre-existing renal insufficiency undergoing robot-assisted laparoscopic radical prostatectomy (RALRP). METHODS: Men with preoperative renal insufficiency (estimated glomerular filtration rate [eGFR] <60 ml/min per 1.73 m(2)) were enrolled and randomized to receive either 0.5 µg/kg per min nicardipine continuous infusion (nicardipine group) or normal saline (control group) during RALRP. Renal function was determined by eGFR and serum creatinine concentration. RESULTS: Serum creatinine levels on postoperative days (POD) 1 and 3 were significantly lower than baseline values in the nicardipine group (n = 50). In the control group (n = 50), eGFR was significantly higher on POD 3 than baseline, and was significantly higher than baseline on POD 1 and 3 in the nicardipine group. The change in eGFR from baseline to POD 1 was significantly higher in the nicardipine group than the control group. CONCLUSION: Continuous infusion of nicardipine during RALRP improved postoperative renal function on POD 1 in patients with pre-existing renal insufficiency.