Search

Neuromuscular blocking agents (NMBAs) are widely used during the induction and maintenance of anesthesia. Postoperative residual curarization (PORC) following the use of NMBAs still occurs even though intermediate-acting NMBAs were used. Train-of-four (TOF) stimulation is used to quantify the degree of neuromuscular blockade. The TOF ratio of 0.7 in the adductor pollicis muscle was associated with normal respiratory function. Pharyngeal function returned to normal while the TOF ratio reached 0.9. The aim of this study was to survey the PORC in the post-anesthesia care unit (PACU).In this observational study, 308 patients who received general anesthesia with NMBAs were enrolled. Residual curarization was evaluated using the TOF-Watch acceleromyograph upon arrival in the PACU. Three consecutive TOF stimulations were applied and recorded at 15-second intervals. Two thresholds of TOF ratios (0.9 and 0.7) were used to assess the presence of residual curarization.TOF ratios less than 0.7 and 0.9 were observed in 15 (5%), and 97 (31%) patients, respectively. The differences of the TOF ratios between the male and female patients were significant (p = 0.014). In terms of weight, the differences between the patients with ratios0.9 andor = 0.9 were significant (p = 0.013). There were 67, 49, 15, and three patients who received reversal medication in the0.9 group,or = 0.9 and0.7 group, andor = 0.7 group, respectively. The differences of the TOF ratios between the patients who received and those who did not receive reversal medication were not significant (p = 0.91).PORC is still a clinical problem in the modern PACU. Objective neuromuscular monitoring needs to be performed to ensure patient safety.

Postoperative nausea and vomiting (PONV) is still a common and major complication for surgical patients, which may delay post-anesthetic care unit discharge, prolong hospital stay and thus increase the cost of hospitalization. It is understood that PONV is a multi-factorial outcome and occurs more often with general anesthesia than with other anesthetic methods. Prophylactic administration of antihistamines, antidopaminergics, anticholinergics, phenothiazines, serotonin antagonist, steroids and even acupuncture has been shown to be effective. However, expenses and side effects of these agents have also been a concern for clinical doctors. The aim for this prospective study was to find an agent that is cost effective and side effect free (or at least with a low incidence of side effects) for the prevention of PONV.A total of 700 adult surgical patients who planned to have surgery under general anesthesia were enrolled in this double-blinded, randomized and placebo-controlled study. Group P received the placebo (0.9% normal saline 2 ml) and Group D received 10 mg dexamethasone intravenously right before the induction of anesthesia.We found that during the postoperative period of 1-8 h, patients in Group D reported a lower incidence of PONV (24%) than those in Group P (39%, p0.001). Patients in Group D also requested less rescue anti-emetic (17%) than those in Group P (30%, p0.05). The same phenomenon was also noted in the 8-to-24-hour interval (PONV 4% vs. 12%, p0.05 and rescue anti-emetic 3% vs. 9%, p0.05 in Group D vs. Group P, respectively.)We conclude that the prophylactic intravenous administration of 10 mg dexamethasone immediately before the induction of anesthesia is effective in preventing PONV in the general surgical adult patient population.

We describe a patient who developed embolic stroke after coronary artery bypass grafting (CABG) associated with intraaortic balloon pump (IABP) insertion. Intraoperative transesophageal echocardiography (TEE) revealed marked irregular mass and disruption of the intimal surface of the thoracic aorta with overlying shaggy echogenic material on the intimal surface of the descending thoracic aortic lumen. This case of stroke after IABP insertion suggested that the balloon inflation fragmented some mobile components on the inner surface of the aorta, and this floating debris entered the systemic circulation. TEE might be able to predict the risk of stroke in such a patient.