Respiratory Arrest after Postoperative Extubation in a Myasthenic Patient who Received Sugammadex to Reverse Neuromuscular Blockade

Postoperative myasthenic crisis is common after thymectomy; the incidence ranges from 12 to 34%. Several factors are known to predict myasthenic crisis and increased risk necessitating postoperative mechanical ventilation, but incomplete postoperative reversal cannot be prevented perfectly. Sugammadex is a medicine that reverses neuromuscular blockade, and can be used to facilitate the return of spontaneous respiration in myasthenic patients. It was recently reported that myasthenic patients rapidly recovered neuromuscular function when sugammadex was used. An 81-year-old, 49 kg woman diagnosed with myasthenia gravis one month previously was admitted for intravenous immunoglobulin G treatment and thymectomy. After thymectomy the patient suffered a myasthenic crisis and respiratory arrest, despite administration of sugammadex to reverse the neuromuscular blockade.This case suggests that more careful and strict evaluation and management should be conducted perioperatively in myasthenic patients, and that the recovery time (time to obtain a train-of-four [TOF] value > 0.9) and spontaneous breathing trial results should be obtained to accurately predict the success of spontaneous breathing.

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Spontaneous Breathing Trial With T-piece or Inspiratory Pressure Augmentation

Case Medical Research ◽

10.31525/ct1-nct04222205 ◽

2020 ◽

Author(s):

Keyword(s):

Spontaneous Breathing ◽

Spontaneous Breathing Trial ◽

Inspiratory Pressure

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Determination of the Optimal Spontaneous Breathing Trial During Weaning of Mechanical Ventilation

Case Medical Research ◽

10.31525/ct1-nct04222569 ◽

2020 ◽

Author(s):

Keyword(s):

Mechanical Ventilation ◽

Spontaneous Breathing ◽

Spontaneous Breathing Trial

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Airway management with I-gelTM for ambulatory laparoscopic inguinal hernia repair in children; a retrospective review of 230 cases

Anaesthesia, Pain & Intensive Care ◽

10.35975/apic.v24i5.1358 ◽

2020 ◽

Vol 24 (5) ◽

Author(s):

Carla Hipólito ◽

Vicente Vieira ◽

Virginia Antunes ◽

Petra Alves ◽

Adriana Rodrigues ◽

...

Keyword(s):

Inguinal Hernia ◽

Hernia Repair ◽

Airway Management ◽

Inguinal Hernia Repair ◽

Neuromuscular Blockade ◽

Retrospective Review ◽

Laparoscopic Inguinal Hernia Repair ◽

Laparoscopic Inguinal Hernia ◽

Increased Risk ◽

The Mean

Background: Inguinal hernia is one of the most common conditions presented for surgical repair in children and laparoscopic approaches are increasingly performed. Previous studies have shown safety and efficacy in the use of supraglottic devices (SGD) as an alternative to tracheal intubation, which fits particularly well with outpatient anesthesia. Methodology: we conduct a retrospective observational study, collecting data from the electronic anesthetic form, from all patients aged 0 to 17 y who underwent ambulatory laparoscopic percutaneous internal ring suturing between February 2015 and August 2019, if I-gelTM was used to airway management. Results: We found 230 patients meeting the inclusion criteria. The mean age was 5.2 y old, mean weight 20.1 kg. All patients were ASA I (n=203) or ASA II (n=27). The mean surgery duration was 38 minutes. We found 4 respiratory adverse events, three bronchospasms, and one laryngospasm, managed in the operating room. Ninety percent of the surgeries were performed without neuromuscular blockade. Conclusion: I-gelTM was a safe, effective, and convenient alternative to airway management to laparoscopic inguinal hernia repair in the ambulatory setting. According to available literature, our practice did not represent an increased risk for the studied respiratory events. SGD obviates the need for neuromuscular blockade. Key words: I-gel; Supraglottic devices; Laparoscopy; Inguinal hernia repair; Pediatrics; Anesthesia, ambulatory Citation: Hipólito C, Vieira V, Antunes V, Alves P, Rodrigues A, Santos MJ. Airway management with I-gelTM for ambulatory laparoscopic inguinal hernia repair in children; a retrospective review of 230 cases. Anaesth. pain intensive care 2020;24(5): Received: 18 February 2020, Reviewed: 5 August, 6 September 2020, Accepted: 11 September 2020

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Comparison of Train of Four Measurements with Kinemyography NMT DATEX and Accelerography TOFscan

Medical Sciences ◽

10.3390/medsci9020021 ◽

2021 ◽

Vol 9 (2) ◽

pp. 21

Author(s):

Cyrus Motamed ◽

Migena Demiri ◽

Nora Colegrave

Keyword(s):

Neuromuscular Blockade ◽

Lower Limit ◽

Elective Surgery ◽

Orotracheal Intubation ◽

Neuromuscular Blocking ◽

Physical Status Classification ◽

Train Of Four ◽

Surgery First ◽

American Society ◽

American Society Of Anesthesiologists

Introduction: This study was designed to compare the Datex neuromuscular transmission (NMT) kinemyography (NMTK) device with the TOFscan (TS) accelerometer during the onset and recovery of neuromuscular blockade. Patients and methods: This prospective study included adult patients who were scheduled to undergo elective surgery with general anesthesia and orotracheal intubation. The TS accelerometer was randomly placed at the adductor pollicis on one hand, and the NMTK was placed on the opposite arm. Anesthesia was initiated with remifentanil target-controlled infusion (TCI) and 2.0–3.0 mg/kg of propofol. Thereafter, 0.5 mg/kg of atracurium or 0.6 mg/kg of rocuronium was injected. If needed, additional neuromuscular blocking agents were administered to facilitate surgery. First, we recorded the train of four (TOF) response at the onset of neuromuscular blockade to reach a TOF count of 0. Second, we recorded the TOF response at the recovery of neuromuscular blockade to obtain a T4/T1 90% by both TS and NMTK. Results: There were 32 patients, aged 38–83 years, with the American Society of Anesthesiologists (ASA) Physical Status Classification I–III included and analyzed. Surgery was abdominal, gynecologic, or head and neck. The Bland and Altman analysis for obtaining zero responses during the onset showed a bias (mean) of 2.7 s (delay) of TS in comparison to NMTK, with an upper/lower limit of agreement of [104; −109 s] and a bias of 36 s of TS in comparison to NMTK, with an upper/lower limit of agreement of [−21.8, −23.1 min] during recovery (T4/T1 > 90%). Conclusions: Under the conditions of the present study, the two devices are not interchangeable. Clinical decisions for deep neuromuscular blockade should be made cautiously, as both devices appear less accurate with significant variability.

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Neuromuscular blockade effects of cisatracurium in 11 cats undergoing ophthalmological surgery anaesthetised with isoflurane

Journal of Feline Medicine and Surgery ◽

10.1177/1098612x211021829 ◽

2021 ◽

pp. 1098612X2110218

Author(s):

Anne-Sophie Van Wijnsberghe ◽

Keila K Ida ◽

Petra Dmitrovic ◽

Alexandru Tutunaru ◽

Charlotte Sandersen

Keyword(s):

Neuromuscular Blockade ◽

Case Series ◽

Neuromuscular Function ◽

Duration Of Action ◽

Cardiovascular Side Effects ◽

Train Of Four ◽

Physical Classification ◽

The Mean ◽

American Society ◽

American Society Of Anesthesiologists

Case series summary This case series describes the neuromuscular blockade (NMB) following 0.15 mg/kg intravenous (IV) cisatracurium administration in 11 cats undergoing ophthalmological surgery and anaesthetised with isoflurane. Anaesthetic records were analysed retrospectively. Neuromuscular function was assessed by a calibrated train-of-four (TOF) monitor. Cats were 73 ± 53 months old, weighed 4 ± 1 kg and were of American Society of Anesthesiologists’ physical classification 2. Duration of anaesthesia and surgery were 144 ± 27 and 94 ± 24 mins, respectively. The lowest TOF count was zero in four cats, four in six cats and for one cat the TOF ratio never decreased below 31%. The time of onset was between 1 and 6 mins after the administration of cisatracurium and the mean duration of action was 20.4 ± 10.1 mins. Relevance and novel information Cisatracurium at a dose of 0.15 mg/kg IV did not consistently induce a TOF count of zero in all cats. The dose used in these cats did not produce any remarkable cardiovascular side effects. Although the NMB was not complete, the dose given was sufficient to produce central eyeball position, which was the goal of the ophthalmic surgeries.

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