Vecuronium in a patient with late cerebellar cortical atrophy.

Little information is available regarding the sensitivity to neuromuscular blocking drugs in patients with spinocerebellar degeneration and associated diseases. We report the response to vecuronium in a patient with late cerebellar cortical atrophy, a nonhereditary type of cerebellar ataxia. Onset time and time to 25% recovery of T1/T0 after vecuronium 0.1 mg.kg(-1) under sevoflurane anesthesia were 156 seconds and 43 minutes, respectively. Recovery index was 27 minutes. We believe this is the first report describing a response to neuromuscular blocking drugs in this disease.

[Severe hyponatremia during transurethral resection of prostate].

We report a case of severe hyponatremia (Na 82 mEq x l(-1)) during transurethral resection of the prostate for benign prostatic hypertrophy. A 61-year-old man was managed with epidural anesthesia and intravenous propofol. Three percent sorbitol (Uromatic S) solution was used for irrigation fluid. The serum sodium level 1 and 3 hours after the start of operation was 103 mEq x l(-1) and 82 mEq x l(-1), respectively. One hour after cessation of propofol administration he did not wake up, although he responded to mechanical stimulation. Saline (1.7%) and sodium bicarbonate (8.4%) were infused. Thirteen hours after the operation, serum sodium level rose to 114 mEq x l(-1), and he opened the eyes on verbal commands. Twenty-eight hours after the operation, serum sodium level was 132 mEq x l(-1). Postoperative neurological deficit did not occur.

The effect of adenosine triphosphate on vecuronium-induced neuromuscular block.

Continuous IV adenosine triphosphate administration has been used during surgery in the expectation of analgesic and vasodilative effects. Because adenosine triphosphate inhibits neuromuscular transmission, we investigated whether the neuromuscular effect of vecuronium was enhanced by IV adenosine triphosphate in 29 patients randomly given either continuous IV adenosine triphosphate 0.1 mg.kg(-1).min(-1) or 0.9% NaCl when undergoing elective minor surgery. Anesthesia was induced and maintained with propofol. Neuromuscular monitoring was recorded from the adductor pollicis muscle using electromyography with train-of-four stimulation of the ulnar nerve. Vecuronium 25, 30, or 40 microg/kg was given and lag time, onset time, and maximum block were recorded. ED50 and ED95 values for each group were derived from least squares linear regression analysis. ED50 and ED95 values were 29 microg/kg and 44 microg/kg, respectively, for the adenosine triphosphate group and 26 microg/kg and 46 microg/kg, respectively, for the controls. Differences in lag time, onset time, and neuromuscular responses between the two groups were not statistically significant. A significantly larger number of patients in the adenosine triphosphate group showed hypotension (systolic blood pressure <80 mm Hg). Our results demonstrated that adenosine triphosphate 0.1 mg.kg(-1).min(-1) did not enhance the neuromuscular block induced by vecuronium.

Subglottic jet ventilation for pediatric microlaryngosurgery: a case report.

A 6-year-old girl with laryngeal papillomatosis underwent ablation of the tumors with Nd-YAG laser under microlaryngosurgery. During the surgery, she was managed with subglottic high-frequency jet ventilation using a stainless steel cannula made from a nerve block needle. It was passed through the light channel of the suspension laryngoscope and firmly affixed to it. There was no hypoxia or barotrauma to the lungs during the surgery. The postoperative course was uneventful.

[Anesthetic management of patients with Poland syndrome: report of two cases].

Poland syndrome is a rare anomaly characterized by unilateral absence of the pectoral muscles and ipsilateral syndactyly and microdactyly. Associated anomalies include defect of ipsilateral ribs and costal cartilages. We report two cases of Poland syndrome. The first case, 24 year old female patient underwent mammoplasty. Although her pectoral muscles were absent, there was no rib or costal cartilage defect. General anesthesia was maintained with assisted spontaneous respiration through laryngeal mask airway. The second case, 18 year old male patient had rib cage defect. Although the patient was asymptomatic when he was awake, paradoxical respiratory movement could have caused inadequate ventilation during general anesthesia. Anesthesia was maintained with intermittent positive pressure ventilation through endotracheal tube during skin flap plasty of latissimus dorsi muscle. In both cases, there was no respiratory complication during perioperative period.

[Transfusion of fresh frozen plasma for massive intraoperative bleeding before and after the new guidelines].

"Guidelines on Blood Products Use" published in 1999 recommends restricting the use of fresh frozen plasma (FFP) solely to correct multiple coagulation factor deficiencies. We retrospectively studied the use of FFP in patients with massive intraoperative bleeding before and after publication of the new guidelines. There were 22 patients whose blood loss was more than their circulating blood volume (7% of body weight) in the past two years. The mean blood loss was 1.4 times of the circulating blood volume both before and after publication of the new guidelines. FFP was given to all 22 patients. The mean dose of FFP decreased from 26.8 ml.kg-1 to 17.8 ml.kg-1 after publication of the new guidelines but the difference was not statistically significant. The volume infused was more than that recommended to improve blood coagulation in massive bleeding, i.e., 8-10 ml.kg-1.

[Manpower at private university hospitals in Japan].

We studied the numbers of teaching staff in anesthesiology departments and of patients operated on and managed by anesthesiologists at private university hospitals in 1999, in Japan. Questionnaires were sent to 49 institutions, and 36 responded (response rate, 73%). The mean number of patients managed by anesthesiologists in an institution was 3899 (range, 942-8135). The mean number of patients who were managed by a staff anesthesiologist was 428 cases (range, 118-980). The data indicate that a prompt increase in manpower at the private university hospitals is necessary to improve patient care, education, and research work.