Comparison Between Sevoflurane and Propofol With Remifentanil Anesthesia Avoid Neuromuscular Blocking Agent After Intubation in Thyroid Operation

Background: The goal of the study is to compare sevoflurane and propofol with remifentanil anesthesia avoid neuromuscular blocking agent after intubation in thyroid operation with intra-operative neuromonitoring.Methods: 80 patients scheduled to receive thyroid operation were randomly assigned to sevofluraneor propofol anesthesia maintained group. The time of rocuronium recovery profile were monitored. Adverse events such as sinus bradycardia, tachycardia, hypertension, hypotension and movement were recorded. Analyze the time from anesthetic stop to the extubation time and operation time. Record the incidence rate of sore throat, drowsiness, agitation, nausea and vomiting after extubation. Record the first neuromonitoring time and the number of successful neuromonitoring.Results: There were significant differences in the recovery profile of rocuronium between sevoflurane and propofol group(P<0.05). The incidence of hypotension was similar between sevoflurane and propofol group. There was no significant difference of sinus braducardia between the two groups. The incidence of movement was less in sevoflurane compared to propofol(12.% vs. 47.5%, P=0.002). The propofol group had longer extubation time than sevoflurane group(13.10±1.52 vs. 8.07±1.07 min, P=0.001).The incidence of sore throat, drowsiness, agitation, nausea and vomiting in the two groups was similar during the recovery period, and the difference was not statistically significant. There was no significant difference of neuromonitoring between the two groups.Conclusion: Sevoflurane has advantage with less movement adverse effects in thyroid surgery with intra-operative neuromonitoring compared to propofol when associated with remifentanil 0.1μg/kg/min in general anesthesia.Trial registration: Chinese Clinical Trial Registry (ChiCTR1800017166, 15 July 2018)

Suxamethonium-Induced Hyperkalemia: A Short Review of Causes and Recommendations for Clinical Applications

After the introduction of suxamethonium in 1953, cases of cardiac arrest during induction of anesthesia were recorded. In the following years, hyperkalemia was identified as the cause, and the connection to acetylcholine receptor modulation as the underlying molecular mechanism was made. Activation of the acetylcholine receptor with suxamethonium, acetylcholine, or choline causes an efflux of potassium to the extracellular space. However, certain pathological conditions cause acetylcholine receptor proliferation and the emergence of immature receptors capable of a larger potassium efflux to the bloodstream. These pathologic conditions include upper and lower neuron injuries, major burns, trauma, immobility, muscle tumors, muscular dystrophy, and prolonged critical illness. The latter is more important and relevant than ever due to the increasing number of COVID-19 patients requiring prolonged respiratory support and consequent immobilization. Suxamethonium can be used safely in the vast majority of patients. Still, reports of lethal hyperkalemic responses to suxamethonium continue to emerge. This review serves as a reminder of the pathophysiology behind extensive potassium release. Proficiency in the use of suxamethonium includes identification of patients at risk, and selection of an alternative neuromuscular blocking agent is imperative.

Efficacy of Botulinum Toxin Stereotype A and Its Relevant Mechanisms of Action in Both Cosmetic and Therapeutic Uses

Onabotulinumtoxin A (Botox®) is a parasympathetic autonomic blocking agent which acts as an inhibitor of the neuromuscular transmitter acetylcholine release and as a neuromuscular blocking agent, thereby inducing relaxation of selected muscle fibers for a duration of up to approximately 3 months duration. First approved by the FDA in 1989 and approved for further applications since 1991, the drug has now gained wide acceptance in cosmetic and other therapeutic applications, where the autonomic neurotransmitter acetylcholine blockade can bring about favorable cosmetic responses, particularly in the field of dermatology and cosmetic medicine. Since the original application of Onabotulinumtoxin A was approved for clinical use as a cosmetic agent, numerous additional applications have been approved by the FDA, all of which involve acetylcholine-mediated neuromuscular actions.