Reversibility of Rocuronium-Induced Deep Neuromuscular Block with Sugammadex in Infants and Children-A Randomized Study.

Sugammadex 4 mg·kg-1 is recommended for reversal from rocuronium-induced deep neuromuscular block. However, there is limited data regarding the dose-response of sugammadex required for reversal from deep neuromuscular block in pediatric patients. The aim of this study was to determine the reversibility of rocuronium-induced deep neuromuscular block with sugammadex in infants and children. Seventy-five children (48 infants and 27 children, mean standard deviation (S.D.), age: 11.6 (6.7) months) were enrolled in this study. After induction of anesthesia and administration of 0.6 mg·kg-1 rocuronium, neuromuscular block was acceleromyographically evaluated by observing contractions of the adductor pollicis muscle to ulnar nerve train-of-four (TOF) stimulation. Subsequently, the intensity of rocuronium-induced block was determined every 6 min using post-tetanic count (PTC) stimulation during sevoflurane and remifentanil anesthesia. When the first response to the PTC stimulus was detected, either 1, 2 or 4 mg·kg-1 sugammadex was administered and the time required for facilitated recovery to a TOF ratio of 0.9 following each dose was compared. The time [mean (S.D.)] from the administration of 1 mg·kg-1 sugammadex until recovery to a TOF ratio of 0.9 was significantly longer [129.1 (83.5) s, p < 0.001] than that with 2 and 4 mg·kg-1 sugammadex [70.3 (26.7) s and 68.2 (34.5) s, respectively]. Incomplete reversal was seen in 3 patients in the 1 mg·kg-1 group. The results suggested that a 4 mg·kg-1 sugammadex dose is recommended for reversal from rocuronium-induced deep neuromuscular block even in infants and children.

Germ cell-less hybrid fish: ideal recipient for spermatogonial transplantation for the rapid production of donor-derived sperm†.

An interspecific hybrid marine fish that developed a testis-like gonad without any germ cells, i.e., a germ cell-less gonad, was produced by hybridizing a female blue drum Nibea mitsukurii with a male white croaker Pennahia argentata. In this study, we evaluated the suitability of the germ cell-less fish as a recipient by transplanting donor testicular cells directly into the gonads through the urogenital papilla. The donor testicular cells were collected from hemizygous transgenic, green fluorescent protein (gfp) (+/-) blue drum, and transplanted into the germ cell-less gonads of the 6-month-old adult hybrid croakers. Fluorescent and histological observations showed the colonization, proliferation, and differentiation of transplanted spermatogonial cells in the gonads of hybrid croakers. The earliest production of spermatozoa in a hybrid recipient was observed at 7 weeks post-transplantation (pt), and 10% of the transplanted recipients produced donor-derived gfp-positive spermatozoa by 25 weeks pt. Sperm from the hybrid recipients were used to fertilize eggs from wild-type blue drums, and approximately 50% of the resulting offspring were gfp-positive, suggesting that all offspring originated from donor-derived sperm that were produced in the transplanted gfp (+/-) germ cells. To the best of our knowledge, this is the first report of successful spermatogonial transplantation using a germ cell-less adult fish as a recipient. This transplantation system has considerable advantages, such as the use of comparatively simple equipment and procedures, and rapid generation of donor-derived spermatogenesis and offspring, and presents numerous applications in commercial aquaculture.

Early development of primordial germ cells in Pacific bluefin tuna Thunnus orientalis.

Bluefin tuna is one of the most important aquaculture species in several countries; however, information regarding the primordial germ cell (PGC) development and migration in this species is scarce. This information is vital for application in reproductive biotechnology, for example, induced sterility through targeted cell ablation or PGC manipulation. Teleost PGC can be visualized by injecting an RNA transcribed from the fusion product of a fluorescent protein gene attached to the 3' untranslated region (3'UTR) of zebrafish nanos3 (zf-nos3) into eggs. In this study, we identified the PGC and its migratory pathway during early embryogenesis and larvae development by injecting the GFP-zf-nos3 3'UTR mRNA into the Pacific bluefin tuna (PBT, Thunnus orientalis). PBT PGCs were initially found around the marginal and dorsal regions of the blastodisc at 50%-epiboly stage. The PGCs were aligned as two elongated lines at the posterior part of the embryonic body during the early segmentation period, and eventually formed a single tight cluster underneath somites 10 to 15 of the embryonic body until the late segmentation period. Although the aggregated PGCs stayed at the same position during hatching, they started migrating anteriorly and were split into two populations at 3 days after hatching (DAH). Until 15 DAH, these PGCs settled in two bilateral lines at the apex of the peritoneal cavity. Histological analysis of PBT larvae revealed that at 3 and 5 DAH, the PGCs were not enclosed by the somatic cells, whereas at 15 DAH, they were entirely covered by the somatic cells, indicating the development of the primordial gonads. These results are essential for future experiments in germ line control technologies for bluefin tuna.

Rocuronium and sugammadex used effectively for electroconvulsive therapy in a patient with Brugada syndrome.

We report the successful anesthetic management of a patient with Brugada syndrome who underwent electroconvulsive therapy to treat bipolar disorder. Suxamethonium and neostigmine were contraindicated to avoid the vagotonic effects that can precipitate ventricular fibrillation during anesthesia in patients with Brugada syndrome. The combination of 1.2 mg/kg rocuronium and 10 mg/kg sugammadex was effectively and safely used to induce and antagonize neuromuscular block for 8 consecutive electroconvulsive therapy sessions in this patient.