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Purpose We compared the reversal doses of sugammadex in surgical cases in which intraoperative neuromuscular monitor were used, to cases in which intraoperative neuromuscular monitoring was not used, retrospectively. Methods Data were collected by reviewing the electronic medical records of patients who received rocuronium and sugammadex during general anesthesia at Asahikawa Medical University Hospital between May 1, 2017 and April 30, 2018. The primary outcome was the reversal dose of sugammadex per patient actual body weight (mg/kg) between the group in which intraoperative neuromuscular monitoring was used (NM+ group) and the group in which intraoperative neuromuscular monitoring was not used (NM- group). Results A total of 3496 patients were evaluated, with 2544 patients (73%) included in NM+ group and 952 patients (27%) in NM- group. The reversal doses of sugammadex per actual body weight were significantly higher in NM- group compared to NM+ group. In the NM+ group, 521 patients (20%) received 2.5 mg/kg sugammadex. In contrast, 128 patients (13%) received 2.5 mg/kg sugammadex in NM- group. Conclusion This single-center retrospective study demonstrated that the use of intraoperative neuromuscular monitor reduced the reversal dose of sugammadex., Author(s): Hajime Iwasaki [sup.1], Atsushi Kurosawa [sup.1], Takafumi Iida [sup.1], Tomoki Sasakawa [sup.1], Hirotsugu Kanda [sup.1] Author Affiliations: (1) grid.252427.4, 0000 0000 8638 2724, Department of Anesthesiology and Critical Care [...]

Introduction: Evidence for the outcomes of endoscopic retrograde cholangiopancreatography (ERCP) between a basket catheter and a balloon catheter for endoscopic common bile duct stone (CBDS) removal is lacking. This study aimed to compare ERCP outcomes using a basket catheter and a balloon catheter for endoscopic CBDS removal. Methods: This multicenter retrospective study included 904 consecutive patients with native papilla who underwent endoscopic stone removal for CBDS ≤10 mm using a basket catheter and/or a balloon catheter at three institutions in Japan. ERCP outcomes between the basket and balloon groups were compared using inverse probability of treatment weighting (IPTW) method. Results: ERCP-related adverse events occurred in 6.5% (29/449) and 7.7% (35/455) of patients in the basket and balloon groups, respectively (IPTW-adjusted p = 0.52). The incidences of post-ERCP pancreatitis, cholangitis, and perforation were similar in the basket and balloon groups (3.8% vs. 2.9%, 1.3% vs. 0.9%, and 0.7% vs. 0.7%, respectively). However, bleeding incidences were significantly higher in the balloon group than in the basket group (3.3% vs. 0.7%, IPTW-adjusted p = 0.012). Successful complete stone removal at one ERCP session using a single catheter was achieved in 17.8% (80/449) in the basket group and in 81.3% (370/455) in the balloon group (IPTW-adjusted p < 0.001). Discussion: A balloon catheter is more likely to complete stone extraction for CBDS ≤10 mm with a single catheter at one endoscopic stone removal session. However, the risk for post-ERCP bleeding is higher in the balloon group than in the basket group. [ABSTRACT FROM AUTHOR]

The set of guidelines for good clinical research practice in pharmacodynamic studies of neuromuscular blocking agents was developed following an international consensus conference in Copenhagen in 1996 (Viby‐Mogensen et al., Acta Anaesthesiol Scand 1996, 40, 59–74); the guidelines were later revised and updated following the second consensus conference in Stockholm in 2005 (Fuchs‐Buder et al., Acta Anaesthesiol Scand 2007, 51, 789–808). In view of new devices and further development of monitoring technologies that emerged since then, (e.g., electromyography, three‐dimensional acceleromyography, kinemyography) as well as novel compounds (e.g., sugammadex) a review and update of these recommendations became necessary. The intent of these revised guidelines is to continue to help clinical researchers to conduct high‐quality work and advance the field by enhancing the standards, consistency, and comparability of clinical studies. There is growing awareness of the importance of consensus‐based reporting standards in clinical trials and observational studies. Such global initiatives are necessary in order to minimize heterogeneous and inadequate data reporting and to improve clarity and comparability between different studies and study cohorts. Variations in definitions of endpoints or outcome variables can introduce confusion and difficulties in interpretation of data, but more importantly, it may preclude building of an adequate body of evidence to achieve reliable conclusions and recommendations. Clinical research in neuromuscular pharmacology and physiology is no exception. [ABSTRACT FROM AUTHOR]

We report the use of rocuronium to re-establish neuromuscular block after reversal with sugammadex. The aim of this study was to investigate the relationship between the dose of rocuronium needed to re-establish neuromuscular block and the time interval between sugammadex administration and re-administration of rocuronium. Patients who required re-establishment of neuromuscular block within 12 h after the reversal of rocuronium-induced neuromuscular block with sugammadex were included. After inducing general anesthesia and placing the neuromuscular monitor, the protocol to re-establish neuromuscular block was as follows. An initial rocuronium dose of 0.6 mg/kg was followed by additional 0.3 mg/kg doses every 2 min until train-of-four responses were abolished. A total of 11 patients were enrolled in this study. Intervals between sugammadex and second rocuronium were 12-465 min. Total dose of rocuronium needed to re-establish neuromuscular block was 0.6-1.2 mg/kg. 0.6 mg/kg rocuronium re-established neuromuscular block in all patients who received initial sugammadex more than 3 h previously. However, when the interval between sugammadex and second rocuronium was less than 2 h, more than 0.6 mg/kg rocuronium was necessary to re-establish neuromuscular block., Author(s): Hajime Iwasaki[sup.1] , Tomoki Sasakawa[sup.1] , Kenichi Takahoko[sup.1] , Shunichi Takagi[sup.2] , Hideki Nakatsuka[sup.3] , Takahiro Suzuki[sup.4] , Hiroshi Iwasaki[sup.1] Author Affiliations: (1) Department of Anesthesiology and Critical Care [...]

The surface of a high-speed tool steel has been modified by an intense pulsed-ion beam (IPIB) that has an ion energy of 180 keV, an ion current density of 460 A/[cm.sup.2], and a pulse duration of 65 ns. Transformation of the crystalline structure in the sample surface layer by IPIB-irradiation was observed by a glancing angle X-ray diffraction and a transmission electron microscopy. The second-phase carbides, [V.sub.4] [C.sub.3], [Cr.sub.6] C, and [Fe.sub.6] C, were dispersed from the irradiated surface layer. A martensitic matrix in the surface layer was converted into an austenitic matrix by ten-pulses-irradiation of the IPIB. After repeated IPIB-irradiation of 100 pulses, a mixed phase of the austenite containing 2.0 wt.% carbon and a cementite was formed in the surface layer. The crystalline size of the sample was reduced from 7 [micro]m for the untreated to 41 nm after 100-pulses-irradiation. The Vickers hardness of the treated surface was Hv=1030 corresponding to 1.2 times of the untreated one. In addition, the friction coefficient of the treated surface was reduced from 1.2 to 0.9, and the wear resistance of the surface was significantly improved. Index Terms--Ion beam application, rapid thermal processing, surface treatment.