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Background The concept of the effect-site concentration of anesthetic agents is important. The effect compartment model can be explained using the concepts of effect-site concentration and effect-site equilibration rate constant (ke0). This study confirms that the time-to-peak effect (tpe) can be measured easily in clinical practice by applying a priming dose and train-of-four (TOF) during general anesthesia induction, and ke0 can be calculated from the tpe of the four muscle relaxants that are commonly used in general anesthesia. Methods Eighty patients who received general anesthesia were divided into the succinylcholine, rocuronium, atracurium, or vecuronium groups. Priming doses of muscle relaxants were administered. The effects of muscle relaxants were quantified by recording the twitch response of the adductor pollicis muscle after stimulating the ulnar nerve. The tpe was measured at the lowest TOF value. ke0 was calculated from the measured tpe. Results The ke0 values of the succinylcholine, rocuronium, atracurium, and vecuronium groups were 0.076 (0.030)/min, 0.228 (0.122)/min, 0.062 (0.011)/min, and 0.077 (0.019)/min, respectively. Conclusions It is possible to estimate ke0 from the tpe of muscle relaxants using a priming dose and TOF during general anesthesia induction.

Background: Tracheal intubation is closely associated with increases in intraocular pressure (IOP); however, the effects of double-lumen tube (DLT) intubation on IOP have not been validated. Systemic hypertension (HTN) is another factor that may increase IOP. In this study, we observed differences in IOP increases between DLT and singlelumen tube (SLT) intubation, and evaluated the influence of underlying HTN during rapid sequence induction. Methods: Sixty-eight patients were allocated into one of the following group: SLT/without HTN (n = 17), SLT/HTN (n = 17), DLT/without HTN (n = 17), and DLT/HTN (n = 17). An SLT was inserted for orthopedic or gynecological surgery, and a DLT was inserted for lung surgery after rapid sequence induction using succinylcholine. IOP was measured before anesthetic induction and until 10 min after intubation using a handheld tonometer (Tono-Pen AVIA®). Results: In the DLT/without HTN and DLT/HTN groups, the maximum increases in IOPs after tracheal intubation were 7.9 and 12.2 mmHg, respectively, compared to baseline. In the SLT/without HTN and SLT/HTN groups, the maximum increases were 5.0 and 4.9 mmHg, respectively, compared to baseline. In comparisons between patients with and without underlying HTN, the values of IOPs were comparable. Conclusions: Tracheal intubation with a DLT is associated with more increases in IOPs than with an SLT in rapid sequence induction. Well-controlled underlying hypertension did not increase IOP during tracheal intubation. [ABSTRACT FROM AUTHOR]

Background: Educators in all disciplines recognize the need to update tools for the modern learner. Mobile applications (apps) may be useful, but real-time data is needed to demonstrate the patterns of utilization and engagement amongst learners. Methods: We examined the use of an anesthesia app by two groups of learners (residents and anesthesiologist assistant students [AAs]) during a pediatric anesthesiology rotation. The app calculates age and weight-based information for clinical decision support and contains didactic materials for self-directed learning. The app transmitted detailed usage information to our research team. Results: Over a 12-month period, 39 participants consented; 30 completed primary study procedures (18 residents, 12 AAs). AAs used the app more frequently than residents (P = 0.025) but spent less time in the app (P < 0.001). The median duration of app usage was 2.3 minutes. During the course of the rotation, usage of the app decreased over time. 'Succinylcholine' was the most accessed drug, while 'orientation' was the most accessed teaching module. Ten (33%) believed that the use of apps was perceived to be distracting by operating room staff and surgeons. Conclusions: Real-time in-app analytics helped elucidate the actual usage of this educational resource and will guide future decisions regarding development and educational content. Further research is required to determine learners' preferred choice of device, user experience, and content in the full range of clinical and nonclinical purposes. [ABSTRACT FROM AUTHOR]

Fever (body temperature above 38°C) is relatively common during the first few days after general anesthesia. Postoperative fever is usually caused by the inflammation induced by surgery and resolves spontaneously; however, it can be a manifestation of a serious complication such as malignant hyperthermia. We report a case of postoperative hyperthermia (body temperature > 40°C) that was refractory to conventional anti-pyretic measures and finally resolved with dantrolene administration. [ABSTRACT FROM AUTHOR]

Background: The concept of the effect-site concentration of anesthetic agents is important. The effect compartment model can be explained using the concepts of effect-site concentration and effect-site equilibration rate constant (ke0). This study confirms that the time-to-peak effect (tpe) can be measured easily in clinical practice by applying a priming dose and train-of-four (TOF) during general anesthesia induction, and ke0 can be calculated from the tpe of the four muscle relaxants that are commonly used in general anesthesia. Methods: Eighty patients who received general anesthesia were divided into the succinylcholine, rocuronium, atracurium, or vecuronium groups. Priming doses of muscle relaxants were administered. The effects of muscle relaxants were quantified by recording the twitch response of the adductor pollicis muscle after stimulating the ulnar nerve. The tpe was measured at the lowest TOF value. ke0 was calculated from the measured tpe. Results: The ke0 values of the succinylcholine, rocuronium, atracurium, and vecuronium groups were 0.076 (0.030)/min, 0.228 (0.122)/min, 0.062 (0.011)/min, and 0.077 (0.019)/min, respectively. Conclusions: It is possible to estimate ke0 from the tpe of muscle relaxants using a priming dose and TOF during general anesthesia induction. [ABSTRACT FROM AUTHOR]

The author discusses use of drugs for prevention of injection pain or withdrawal movement (IPWM) caused due to rocuronium bromide injection used for anesthetic induction. Topics include use of rocuronium injection in children due to complications by succinylcholine, consequences due to pain on the injection including bronchospasm, myocardial infarction and pulmonary aspiration, the efficacy of drug sevoflurane combined with remifentanil for relieving pain due to the injection in children.

Background: The concept of the effect-site concentration of anesthetic agents is important. The effect compartment model can be explained using the concepts of effect-site concentration and effect-site equilibration rate constant ( k e0 ). This study confirms that the time-to-peak effect ( t pe ) can be measured easily in clinical practice by applying a priming dose and train-of-four (TOF) during general anesthesia induction, and k e0 can be calculated from the t pe of the four muscle relaxants that are commonly used in general anesthesia., Methods: Eighty patients who received general anesthesia were divided into the succinylcholine, rocuronium, atracurium, or vecuronium groups. Priming doses of muscle relaxants were administered. The effects of muscle relaxants were quantified by recording the twitch response of the adductor pollicis muscle after stimulating the ulnar nerve. The t pe was measured at the lowest TOF value. k e0 was calculated from the measured t pe ., Results: The k values of the succinylcholine, rocuronium, atracurium, and vecuronium groups were 0.076 (0.030)/min, 0.228 (0.122)/min, 0.062 (0.011)/min, and 0.077 (0.019)/min, respectively.e0 values of the succinylcholine, rocuronium, atracurium, and vecuronium groups were 0.076 (0.030)/min, 0.228 (0.122)/min, 0.062 (0.011)/min, and 0.077 (0.019)/min, respectively., Conclusions: It is possible to estimate k e0 from the t pe of muscle relaxants using a priming dose and TOF during general anesthesia induction.