[A case of postoperative palsy of the brachial plexus and facial nerve caused by use of cervical collar during lung surgery].

We report a case of palsy of the brachial plexus and facial nerve manifested after surgery for lung cancer in a 77-year-old female who also had a retroodontoid pseudotumor. Lobectomy was conducted with the patient in a left lateral position. For the purpose of cervical stabilization, the orthopedic surgeon recommended the use of a cervical collar. During the operation, both of her arms were abducted at nearly 80 degrees. On the second postoperative day, the patient complained of sensory disturbances in the lateral area of her left brachium and forearm, which are innervated by the 5th and 6th cervical spinal nerves from the brachial plexus. She also complained that she could not abduct and flex her left shoulder, and could not flex her left elbow at all. Simultaneously, facial nerve palsy was observed in her left lower lip. During the operation, her shoulders were forcibly rotated internally and were extremely abducted, resulting in a narrowed distance between the lower jaw and the shoulder and stretching of the brachial plexus. Under this situation, the cervical collar was pressing strongly upon her neck and lower jaw, which might have produced the brachial plexus complication and facial nerve palsy.

Vecuronium directly inhibits hypoxic neurotransmission of the rat carotid body.

UNLABELLED: Previous studies have suggested that partial neuromuscular blockade by vecuronium may inhibit the chemoreceptor neural response to hypoxia. Because acetylcholine and its receptors are critically involved in the hypoxic neurotransmission of the carotid body, we examined whether vecuronium interferes with nicotinic processes in the carotid body and inhibits the chemoreceptor neural response to hypoxia. The carotid body was harvested from anesthetized adult Wister rats. Carotid sinus nerve activity (CSNA) was recorded in vitro, whereas the carotid body was perfused with Krebs solutions equilibrated with 5% CO(2)/air or 5% CO(2)/N(2). Vecuronium (0.1, 0.5, and 5 microM) was administered via perfusion. Hypoxic perfusion increased CSNA and the response remained stable for two hours. With vecuronium 0.5 and 5 microM, the increase in CSNA (DeltaCSNA) in response to hypoxia was significantly attenuated. The inhibitory effect of vecuronium was dose-related. Acetylcholine and nicotine increased CSNA, and the values of DeltaCSNA were significantly attenuated by vecuronium. These results indicate that vecuronium directly inhibits the carotid body neural response to hypoxia, possibly because of the inhibition of neuronal nicotinic receptors in the carotid body. IMPLICATIONS: We investigated the effect of vecuronium on the chemoreceptor response to hypoxia with perfused rat carotid bodies. The results indicate that vecuronium significantly reduces carotid body neural responses to hypoxia, acetylcholine, and nicotine by inhibiting neuronal nicotinic receptors in the carotid body.