High Temperature Deformation Characteristics of Al-Zn-Mg Alloy Modified with CaO-Added Mg.

Hot torsion tests were performed on an Al-Zn-Mg alloy modified with CaO-added Mg to investigate the effects of the Mg additive on the high temperature deformation characteristics. Effective stress- strain curves and processing maps were established from the experimental results under a range of deformation conditions. The fracture strain of the CaO-added Al-Zn-Mg alloy was higher than that of the Al-Zn-Mg alloy. The CaO-added Al-Zn-Mg alloy did not show an instability region in the processing map but the commercial Al-Zn-Mg alloy exhibited adiabatic shear bands at low temperatures and at a high strain rate. The results shown in this study were attributed to the reduction of the second phase by the addition of CaO-added Mg.

Evaluation of the Hot Workability of Commercially Pure Ti Using Hot Torsion Tests.

Optimum processing conditions were obtained by evaluating the hot working behavior of commercially pure Ti using hot torsion tests. Hot torsion tests were conducted at temperatures ranging from 800 °C-1000 °C and strain rates ranging from 0.1-10 s-1. The flow curves show that the peak stress increases as the temperature decreases and the strain rate increases. The optimum processing conditions were derived by comparing the processing and activation energy maps. The microstructure was characterized based on various regions of the processing map. The activation energy for plastic deformation was obtained using the constitutive equation. The activation energy differs depending on the constituent phases.

Immediate hypersensitivity reaction to Ketamine in children with history of atopic disease.

Many investigators have demonstrated that a large number of patients who experience anaphylaxis during anesthesia have a history of atopic disease or allergy to a specific substance. Here, we review a hypersensitivity reaction to ketamine in a nine-year-old child with a history of atopic disease.

Application of Palliative Hemostatic Radiotherapy in Canine Unresectable Oral Melanoma: A Case Report.

A 9-year-old castrated male Schnauzer dog, weighing 11.6 kg, presented with a persistent hemorrhagic oral mass. An oral examination revealed a right maxillary oral mass characterized by continuous bleeding, halitosis, and severe pain. A cytological examination led to a provisional diagnosis of malignant melanoma, and, despite the option of aggressive surgery, the owner declined. The blood analysis indicated severe hemorrhagic anemia (hematocrit, 18.2%) requiring a blood transfusion. The patient underwent volumetric modulated arc therapy (VMAT) as part of a palliative radiation protocol, receiving six fractions of 6 Gy weekly for hemostasis and clinical improvement. The hemorrhaging ceased after the second fraction, with a subsequent rise in the hematocrit levels and the resolution of the anemia. Additionally, the intake increased following the second fraction, and effective pain management was achieved in the fourth fraction. Following the last fraction, computed tomography revealed a 20% reduction in the tumor size. This case highlights the potential use of radiotherapy for hemostasis in cases of inoperable hemorrhagic oral melanoma and represents the first report on the application of hemostatic radiotherapy in dogs.

Injection rate, scanning position, and values of parameters on pulmonary computed tomography perfusion in normal Beagles.

OBJECTIVE: This study evaluated the effects of scanning position and contrast medium injection rate on pulmonary CT perfusion (CTP) images in healthy dogs. ANIMALS: 7 healthy Beagles. METHODS: Experiments involved 4 conditions: dorsal and sternal recumbency at 2.5 mL/s (first) and sternal recumbency with additional rates of 1.5 and 3.5 mL/s (second). Various parameters, including the initial time of venous enhancement (Tv), peak time of arterial enhancement (PTa), and peak enhancement values of the artery, were measured. The PTa to Tv interval was calculated. Perfusion mapping parameters (pulmonary blood flow, pulmonary blood volume, mean transit time, time to maximum, and time to peak) were determined in different lung regions (left and right dorsal, middle, and ventral). RESULTS: There are significant variations in most perfusion mapping parameters based on the pulmonary parenchymal location. Dorsal recumbency had a lower peak value of arterial enhancement than sternal recumbency. Pulmonary blood flow in the dorsal region and mean transit time and time to maximum in all regions showed no significant differences based on position. Pulmonary blood volume and time to peak varied with scanning position. The PTa to Tv interval did not differ based on the injection rate, but the injection time at 1.5 mL/s was longer than at other rates. All perfusion mapping parameters of the ventral region increased with higher injection rates. CLINICAL RELEVANCE: The recommended CTP imaging approach in dogs is a low injection rate of 1.5 mL/s in the sternal recumbency. This study provides reference ranges for perfusion parameters based on the pulmonary parenchymal location, contributing to the acquisition and application of pulmonary CTP images for differential diagnosis in small-breed dogs.

Effect of neoadjuvant chemotherapy on effect-site concentration of propofol for sedation in patients with breast cancer.

BACKGROUND: Some studies have demonstrated that chemotherapy drugs enhance sensitivity to anesthetics owing to its systemic toxicity, while others have demonstrated that chemotherapy drugs have no effect. This study aimed to determine whether neoadjuvant chemotherapy influences the effect-site concentration (Ce) of propofol for sedation in patients withbreast cancer. METHODS: This study included patients aged 19-75 years who were scheduled to undergobreast cancer surgery under general anesthesia. Patients who received neoadjuvant chemotherapy were assigned to group C, whereas those who never received chemotherapy wereassigned to group N. Propofol was administered through an effect-site target-controlled infusion, and the Modified Observer's Assessment of Alertness/Sedation scale (MOAA/S) scoreand Bispectral Index (BIS) were recorded. When the plasma concentration and Ce wereequal to the target Ce, and if the MOAA/S score did not change, the target Ce was increasedby 0.2 µg/ml; otherwise, the Ce was maintained for 2 min and then increased. This processwas repeated until the MOAA/S score became 0. RESULTS: No significant differences were observed in Ce values at each sedation level between both groups. Ce values for loss of consciousness (LOC) of groups C and N were 2.76± 0.29 and 2.67 ± 0.27 µg/ml (P = 0.285), respectively. However, the BIS value at LOC ofgroup C (63.87 ± 7.04) was lower than that (68.44 ± 6.01) of group N (P = 0.018). CONCLUSIONS: Neoadjuvant chemotherapy for breast cancer has no effect on the Ce ofpropofol for sedation.

Case report: Radiography and computed tomography of tension pneumoperitoneum caused by gastric perforation in a dog.

Tension pneumoperitoneum is characterized by excessive accumulation of gas in the peritoneal cavity, which leads to cardiorespiratory distress. We present the case of a 4-year-old female Labrador retriever who presented with a severe abdominal distension and panting. Radiography revealed a large volume of free gas in the peritoneal cavity with decreased serosal detail. After emergency needle decompression, ultrasound-guided aspiration of the peritoneal effusion helped confirm septic peritonitis. Computed tomography revealed a gastric mass measuring approximately 3.7 × 5.0 × 5.5 cm, which was suspected to have caused the gastric perforation. A large volume of free gas was present in the peritoneal cavity, causing compression and centralization of the abdominal organs. A low-attenuating cleft suggestive of perforation site near the gastric mass was also observed. Exploratory laparotomy confirmed gastric perforation of approximately 2.2 cm adjacent to the gastric mass. The patient was finally diagnosed with tension pneumoperitoneum caused by gastric perforation. The mass was resected with a 1-2-cm surgical margin, and imprinting cytology indicated gastric carcinoma. The patient was aggressively treated with fluid, analgesic, antithrombotic, and antibacterial therapy. However, the patient's condition continued to deteriorate, and euthanasia was performed at the owner's request. Our report is the first to describe the multimodal imaging features of a dog with tension pneumoperitoneum secondary to gastric perforation caused by gastric neoplasm.

Evaluating medical students' ability to identify and report errors: finding gaps in patient safety education.

BACKGROUND: Although there are frequent complaints of medical students' incompetence in reporting errors, few studies have examined their error-reporting abilities in the real world. OBJECTIVES: Three sub-functions of self-regulation theory were used to evaluate medical students' ability to identify errors (self-monitoring), analyse root causes (self-judgment), and devise improvement plans (self-reactions). In addition, whether students reacted differently to their errors and those of others (three sub-functions) was also examined. METHODS: A total of 952 patient safety reports were reviewed retrospectively, submitted by third-year medical students between 2016 and 2018. Data were quantitatively and qualitatively analysed to investigate who committed the error, to identify the type of error and its root causes, and to find suggested improvement plans. Chi-square and Fisher's exact tests were used to compare students' responses to error origins. RESULTS: Students reported other errors more frequently than their own (67.6% vs. 32.4%). They reported common critical medical errors, including errors related to engaging with patients (34.5%), invasive procedures (20.2%), and infection (18.5%). The root causes identified were more precise than the improvement plans by the students (75.5% vs. 18.4%, respectively). The students' improvement plans were not practical, especially at the patient level (25.8%). When students committed errors, they considered human factors such as fatigue, scheduling, and training as the most common root cause, focussing on improvement plans at the individual level. CONCLUSIONS: The results suggest that students were good at self-judgment, but not at self-monitoring and self-reactions. They reacted differently, based on who committed the error. To enhance self-regulated learning, Educators should encourage students to confront their errors, reflect on their self-reactions towards errors, develop well-being with time management, and think about the meaning of patient-centredness. Finally, active participation in clinical clerkship longitudinally may provide students with opportunities to learn from their errors.

Regeneration of interfacial bonding force of waste carbon fibers by light: Process demonstration and atomic level analysis.

Although interest in recycling carbon fibers is rapidly growing, practical applications of recycled carbon fibers (rCFs) are limited owing to their poor wettability and adhesion. Surface modification of CFs was achieved through intense pulsed light (IPL) irradiation, which functionalizes surface of rCFs. Surface energy, chemical composition, morphology, and interfacial shear strength (IFSS) of rCFs before and after IPL irradiation were investigated. The rCF IPL-irradiated at 1,200 V improved both polar and dispersive components of surface energy, and the IFSS significantly increased by 2.93 times in relation to that of the pristine rCF and reached 95% of that of high-grade commercial CFs. We proposed a mechanism by which oxygen functional groups on the rCF surface enhance the molecular bonding force with HDPE, and the model was validated from molecular dynamics simulations. IPL irradiation is a rapid and effective surface treatment method that can be employed for the manufacture of rCF-reinforced composites.

Effect of chemotherapy on effect-site concentration of propofol for loss of consciousness in patients with colorectal cancer.

BACKGROUND: The depth of anesthesia is an essential factor in surgical prognosis. The neurotoxic effect of chemotherapeutic drugs affects the sensitivity to anesthetics. This study was conducted to determine whether the effect-site concentration (Ce) of propofol for loss of consciousness (LOC) differs in patients undergoing preoperative chemotherapy. METHODS: A total of 60 patients scheduled for surgery for colorectal cancer under general anesthesia were included in this study. Patients who had received chemotherapy comprised the experimental (C) group, and those without a previous history of chemotherapy comprised the control (N) group. Propofol was administered as an effect-site target-controlled infusion, and the Modified Observer's Assessment of Alertness/Sedation (MOAA/S) scores were evaluated. When the plasma concentration and Ce were similar, and if the MOAA/S score did not change, the target Ce was increased by 0.2 µg/ml; otherwise, the Ce was maintained for 2 min and then increased. RESULTS: The Ce values of propofol for loss of verbal contact (LVC) in groups C and N were 2.40 ± 0.39 and 2.29 ± 0.39 µg/ml (P = 0.286), respectively, and those for LOC in groups C and N were 2.69 ± 0.43 and 2.50 ± 0.36 µg/ml (P = 0.069), respectively. No significant difference was observed in Ce values between the two groups. CONCLUSIONS: Chemotherapy had no effect on the Ce of propofol for LVC and LOC in patients with colorectal cancer. We do not recommend reducing the dose of propofol for the induction of LOC in patients with colorectal cancer undergoing chemotherapy.

Feasibility of ultrasonographic hepatic parenchymal attenuation imaging in healthy Beagles.

OBJECTIVE: To investigate the clinical feasibility of attenuation imaging of the hepatic parenchyma in healthy dogs, identify technical factors that influence measured attenuation coefficients, and determine intraobserver repeatability of measurements. ANIMALS: 10 healthy Beagles. PROCEDURES: Attenuation coefficients were calculated for various measurement sites (left vs central division of the liver), scanning planes (transverse vs sagittal plane), scanning depths (10 to 20 mm vs 20 to 30 mm), scanning approaches (intercostal vs subcostal approach), and breathing conditions (free breathing vs breath holding at end expiration). Intraoperator intraday and interday reliability was assessed by computing intraclass correlation coefficients. RESULTS: Attenuation coefficients were not influenced significantly by scanning plane (P = .120 to 1.000), measurement site (P = .292 to .848), or breathing condition (P = .166). However, coefficients were significantly (P < .01) less with deeper scanning depths and significantly (P < .05) more for the subcostal approach than the intercostal approach. The intraday and interday intraclass correlation coefficients showed good repeatability (0.799 and 0.771, respectively), regardless of the scanning plane and measurement site. Scanning the central division of the liver with the right intercostal approach at a depth of 10 to 20 mm from the liver capsule yielded good reliability. CLINICAL RELEVANCE: Attenuation imaging was a feasible technique for evaluating the hepatic parenchyma in healthy dogs with good repeatability. Measured attenuation coefficients were not affected by the scanning plane, measurement site, or breathing condition.

Additional effect of magnesium sulfate and vitamin C in laparoscopic gynecologic surgery for postoperative pain management: a double-blind randomized controlled trial.

BACKGROUND: This clinical trial was conducted to determine whether combined use of magnesium sulfate and vitamin C more significantly reduced postoperative fentanyl consumption and pain than magnesium sulfate or vitamin C alone. METHODS: The prospective, double-blinded, randomized controlled study enrolled 132 patients scheduled for laparoscopic gynecologic surgery. The patients were randomly allocated to one of the four groups (n = 33 for each group; Group M [magnesium sulfate 40 mg/kg], Group V [vitamin C 50 mg/kg], Group MV [magnesium sulfate 40 mg/kg and vitamin C 50 mg/kg] and Group C [isotonic saline 40 ml]). Cumulative postoperative fentanyl consumption (primary endpoint measure), postoperative pain score by numeric rating scale, and postoperative nausea and vomiting were recorded at 1, 6, 24, and 48 h after discharge from the postanesthesia care unit. RESULTS: Cumulative postoperative fentanyl consumption was significantly less in Groups M, V, and MV than in Group C at all time points. Group MV showed significantly less cumulative postoperative fentanyl consumption than Group M at postoperative 24 h (mean ± standard deviation, 156.6 ± 67.5 vs. 235.6 ± 94.6 µg, P = 0.001), as well as significantly less consumption than Groups M and V at postoperative 48 h (190.8 ± 74.6 vs. 301.0 ± 114.8 or 284.1 ± 128.6 µg, P < 0.001, P = 0.003, respectively). CONCLUSIONS: Combined use of magnesium sulfate and vitamin C provides an additional benefit in postoperative pain management after laparoscopic gynecologic surgery in comparison to single administration of magnesium sulfate or vitamin C.

The question of preoperative anxiety and depression in older patients and family protectors.

BACKGROUND: Higher levels of anxiety increase the risks of surgery, including morbidity and mortality. The objectives of this study were to measure anxiety and depression during the preoperative period and to identify the degree of knowledge and concerns of older patients and their family protectors regarding anesthesia, and the causes of these concerns. METHODS: We administered a questionnaire to older patients scheduled to undergo surgery and their family protectors one day prior to the surgery. The questionnaire included tools for quantifying anxiety and depression (Anxiety-Visual Analogue Scale, the Amsterdam Preoperative Anxiety and Information Scale, State-Trait Anxiety Inventory Korean YZ Form, and Short Form Geriatric Depression Scale). We also asked about the concrete causes of anxiety using pre-created forms. RESULTS: There were 140 older patients and family protectors who participated in the study. The majority of older patients (n = 114, 81.4%) undergoing surgery and their family protectors (n = 114, 81.4%) indicated that they were anxious. Most of the older patients and their family protectors responded that they had insufficient knowledge about anesthesia, and they were mostly worried about failure to awaken following surgery, and postoperative pain. Older patients with higher anxiety scores showed higher depression scores. There were significant differences in depression scores depending on the presence of cohabitating family members. CONCLUSIONS: It is important to remember that older patients with higher depression scores have higher anxiety during the preoperative period.

Vocal cord paralysis following general anesthesia with endotracheal intubation: a clinical review on 43 cases.

BACKGROUND: Vocal cord paralysis (VCP) is one of the most stressful experiences for patients undergoing general anesthesia. Moreover, it is a risk factor for aspiration pneumonia and may increase morbidity and mortality. We examined several clinical features of the condition by reviewing the medical records of patients who experienced VCP following general anesthesia. METHODS: We reviewed the medical records of 321 patients who consulted an otolaryngologist owing to hoarseness, sore throat, throat discomfort, or dysphagia after general anesthesia. Among these, we included in the present study 43 patients who were diagnosed with VCP by laryngoscopy, who did not have symptoms of suspected VCP before surgery, who had no past history of VCP, and for whom endotracheal intubation was not continued after surgery. RESULTS: The mean age of patients with VCP was 51.3 years. With respect to surgical site, the most common was upper limb surgery, performed in 12 cases (9 cases were performed in sitting posture. With respect to surgical duration, only 11 cases lasted less than 3 h, whereas 32 cases required a surgical duration longer than 3 h. The most common symptom of VCP was hoarseness. Nine of the patients with VCP recovered spontaneously, but VCP persisted in 13 cases until the final follow-up examination. CONCLUSIONS: We hope that this study might call attention to the occurrence of VCP following general anesthesia. Moreover, it is necessary to further evaluate the reasons for the higher incidence of VCP in upper limb surgery performed in sitting posture.

Effect of dexamethasone gargle, intravenous dexamethasone, and their combination on postoperative sore throat: a randomized controlled trial.

BACKGROUND: Postoperative sore throat (POST) is a complication that decreases patient satisfaction and increases postoperative complaints. The present study was conducted to investigate effects of gargling with dexamethasone, intravenous dexamethasone injection and the combination of the two on the incidence and severity of POST. METHODS: Study participants were 96 patients who had undergone laparoscopic cholecystectomy, randomly allocated into three groups. Group G gargled with 0.05% dexamethasone solution and were infused intravenous 0.9% normal saline before general anesthesia; group I gargled with 0.9% normal saline and were infused intravenous 0.1 mg/kg dexamethasone; group GI gargled with 0.05% dexamethasone solution and were infused intravenous 0.1 mg/kg dexamethasone. The incidence and severity of POST, hoarseness and cough were evaluated and recorded at 1, 6, and 24 h after the surgery. RESULTS: There were no significant differences in the total incidence of POST up to 24 postoperative hours among Group G, Group I and Group GI (P = 0.367, Group G incidence = 34.38%, [95% confidence interval, 95% CI = 17.92-50.83], Group I incidence = 18.75%, [95% CI = 5.23-32.27], Group GI incidence = 28.13%, [95% CI = 12.55-43.70]). The other outcomes were comparable among the groups. CONCLUSIONS: In patients who had undergone laparoscopic cholecystectomy, gargling with 0.05% dexamethasone solution demonstrated the same POST prevention effect as intravenous injection of 0.1 mg/kg dexamethasone. The incidence and severity of POST were not significantly different between the combination of gargling with 0.05% dexamethasone solution and intravenous injection of 0.1 mg/kg dexamethasone and use of each of the preventive methods alone.

Dislocation Structure in Hot Deformed Al-Zn-Mg Alloy by X-ray Line Profile Analysis.

The microstructure of extruded Cu-free Al-Zn-Mg alloy is studied. Hot torsion tests are performed on a Cu-free Al-Zn-Mg alloy to investigate the effect of large strain deformation on the dislocation behavior. The dislocation structure is characterized by X-ray diffraction profile analysis, and the effective stress-strain curves are obtained by hot torsion tests. The dislocation density at low deformation temperature is found to be higher than that at high deformation temperature. The dislocation density of the alloy increases gradually up to ε = 1 with increasing strain and does not change significantly during further deformation.

Effects of topical dexamethasone in postoperative sore throat.

BACKGROUND: Postoperative sore throat (POST) is a complication that undermines patient satisfaction and increases discomfort in the postoperative period. The present study examined the effects of dexamethasone gargle and endotracheal tube cuff soaking on the incidence and severity of POST. METHODS: Ninety patients undergoing laparoscopic cholecystectomy were randomly allocated into three groups: 0.9% normal saline gargling and tube soaking (group C), 0.05% dexamethasone solution gargling and 0.9% normal saline tube soaking (group G), 0.9% normal saline gargling and 0.05% dexamethasone tube soaking (group S). The incidence and severity of POST were then assessed and recorded at 24 hours after surgery. RESULTS: The total incidence of POST was significantly different among the groups (P < 0.05), and group S exhibited a significantly lower incidence of POST than group C (P < 0.0167). In addition, the POST intensity of group G and group S was less severe than those of group C (Both P < 0.0167). CONCLUSIONS: Among patients undergoing laparoscopic cholecystectomy, those who gargled with 0.05% dexamethasone solution exhibited lower severity of POST than the control group, and those whose endotracheal tube cuff was soaked in the dexamethasone solution before intubation exhibited significantly lower incidence and severity of POST than the control group.

Preoperative interscalene brachial plexus block aids in perioperative temperature management during arthroscopic shoulder surgery.

BACKGROUND: Hypothermia is common during arthroscopic shoulder surgery under general anesthesia, and anesthetic-impaired thermoregulation is thought to be the major cause of hypothermia. This prospective, randomized, double-blind study was designed to compare perioperative temperature during arthroscopic shoulder surgery with interscalene brachial plexus block (IBPB) followed by general anesthesia vs. general anesthesia alone. METHODS: Patients scheduled for arthroscopic shoulder surgery were randomly allocated to receive IBPB followed by general anesthesia (group GB, n = 20) or general anesthesia alone (group GO, n = 20), and intraoperative and postoperative body temperatures were measured. RESULTS: The initial body temperatures were 36.5 ± 0.3℃ vs. 36.4 ± 0.4℃ in group GB vs. GO, respectively (P = 0.215). The body temperature at 120 minutes after induction of anesthesia was significantly higher in group GB than in group GO (35.8 ± 0.3℃ vs. 34.9 ± 0.3℃; P < 0.001). The body temperatures at 60 minutes after admission to the post-anesthesia care unit were 35.8 ± 0.3℃ vs. 35.2 ± 0.2℃ in group GB vs. GO, respectively (P < 0.001). The concentrations of desflurane at 0, 15, and 120 minutes after induction of anesthesia were 6.0 vs. 6.0% (P = 0.330), 5.0 ± 0.8% vs. 5.8 ± 0.4% (P = 0.001), and 3.4 ± 0.4% vs. 7.1 ± 0.9% (P < 0.001) in group GB vs. GO, respectively. CONCLUSIONS: The present study demonstrated that preoperative IBPB could reduce both the intraoperative concentration of desflurane and the reduction in body temperature during and after arthroscopic shoulder surgery.

Intracellular transduction of TAT-Hsp27 fusion protein enhancing cell survival and regeneration capacity of cardiac stem cells in acute myocardial infarction.

Myocardial infarction (MI) results in the substantial loss of functional cardiomyocytes, which frequently leads to intractable heart disorders. Cardiac stem cells (CSCs) that retain the capacity to replace all cardiac cells might be a promising strategy for providing a source of new functional cardiomyocytes; however, the poor survival and engraftment of transplanted CSCs in the hostile environment of MI critically mitigate their therapeutic benefits. To capitalize their therapeutic potential, an ex vivo strategy in which CSCs were introduced to the recombinant heat shock protein 27 (Hsp27) through a TAT protein transduction domain for increasing the viability and engraftment in the infarcted myocardium was designed. A recombinant TAT fused Hsp27 (TAT-Hsp27) was able to enter CSCs in a dose-dependent manner. CSCs transduced with TAT-Hsp27 expressed not only endogenous Hsp27 but externally introduced Hsp27, resulting in substantial increase of their anti-oxidative and anti-apoptotic properties via suppressing reactive oxygen species production, the MAPKs signaling pathway, and caspase activation. TAT-Hsp27 enabled CSCs to be protected from apoptotic- and hypoxic-induced cell death during in vitro cardiomyogenic differentiation. In vivo studies demonstrated that CSCs transduced TAT-Hsp27 significantly increased the survival and engraftment in the acutely infarcted myocardium, which is closely related to caspase activity suppression. Finally, CSCs transduced TAT-Hsp27 improved cardiac function and attenuated cardiac remodeling in comparison with non-transduced CSCs. Overall, our approach, which is based on the ex vivo intracellular transduction of TAT-Hsp27 into CSCs before myocardial delivery, might be effective in treating MI.

The combination of sugammadex and neostigmine can reduce the dosage of sugammadex during recovery from the moderate neuromuscular blockade.

BACKGROUND: Sugammadex is a novel neuromuscular reversal agent, but its associated hypersensitivity reaction and high cost have been obstacles to its widespread use. In the interest of reducing the necessary dosage of sugammadex, the reversal time of the combined use of sugammadex and neostigmine from moderate neuromuscular blockade were investigated. METHODS: The patients enrolled ranged in age from 18 to 65 years old with American Society of Anesthesiologists class 1 or 2. The subjects were randomly assigned into one of the four groups (Group S2, S1, SN, and N; n = 30 per group). The reversal agents of each groups were as follows: S2 - sugammadex 2 mg/kg, S1 - sugammadex 1 mg/kg, SN - sugammadex 1 mg/kg + neostigmine 50 µg/kg + glycopyrrolate 10 µg/kg, N - neostigmine 50 µg/kg + glycopyrrolate 10 µg/kg. The time to recovery of the train-of-four (TOF) ratio was checked in each group. RESULTS: The time to 90% recovery of TOF ratio was 182.6 ± 88.9, 371.1 ± 210.4, 204.3 ± 103.2, 953.2 ± 379.7 sec in group S2, S1, SN and N, respectively. Group SN showed a significantly shorter recovery time than did group S1 and N (P < 0.001). However, statistically significant differences between the S2 and SN groups were not be observed (P = 0.291). No hypersensitivity reactions occurred in all groups. CONCLUSIONS: For the reversal from rocuronium-induced moderate neuromuscular blockade, the combined use of sugammadex and neostigmine may be helpful to decrease the recovery time and can also reduce the required dosage of sugammadex. However, the increased incidence of systemic muscarinic side effects must be considered.