[A two-year-old patient who received readministration of rocuronium for re-operation 30 minutes after sugammadex reversal].

Little is known about doses and onset times of rocuronium after sugammadex reversal. We report a 2-year-old girl receiving readministration of rocuronium for reoperation 30 minutes after sugammadex reversal. The patient underwent ventriculoperitoneal shunting for hydrocephalus under general anesthesia with muscle relaxation by rocuronium. After completion of surgery, muscle relaxation was antagonized by sugammadex 4 mg x kg(-1). Thirty minutes after extubation, reintubation and readministration of rocuronium were required for additional surgery. Rocuronium was administered again under monitoring of muscle relaxation. As the efficacy of rocuronium was definitively reduced, a higher dose (2 mg x kg(-1)) and a longer onset time (6 minutes) were required to establish maximal block (T1 0%). There were no apparent problems with the clinical duration of rocuronium or repetitive antagonization by sugammadex. Under appropriate monitoring, repetitive muscular relaxation by rocuronium can be safely established.

[Perioperative management of patients with cancer-pain receiving fentanyl patch].

Two patients with cancer medicated by transdermal fentanyl patch (FP) for more than one month underwent operation under general anesthesia. FP had not been removed. Anesthesia was maintained with inhalation of sevoflurane 2-3%, nitrous oxide, and intermittent administration of intravenous fentanyl. Intraoperative course was uneventful. They recovered from anesthesia quickly, and there were no complications due to fentanyl during the perioperative course. One patient needed additional intravenous fentanyl for postoperative analgesia. When FP is applied during the operation, it is useful because it can be of use for postoperative pain control.

Sensitivity to vecuronium in seropositive and seronegative patients with myasthenia gravis.

UNLABELLED: Patients with myasthenia gravis (MG) are hypersensitive to nondepolarizing neuromuscular blocking drugs. Although antibodies to the acetylcholine receptor (AChR) often are observed in MG patients, 10% to 30% of patients do not show an anti-AChR antibody. Little is known about differences in sensitivity to nondepolarizing neuromuscular blocking drugs between MG patients with and without anti-AChR antibody. Hypothesizing that seronegative patients are as sensitive to vecuronium as seropositive patients, we assessed sensitivity in seropositive and seronegative MG patients and in non-MG patients (n = 8 each). During anesthesia with sevoflurane (2.5%) and nitrous oxide (60%) in oxygen, neuromuscular transmission was monitored by measuring the twitch tension of the adductor pollicis muscle with supramaximal stimulation. After baseline measurements, 10 microg/kg IV dose increments of vecuronium were administered sequentially until blockade exceeded 90%. The degree of blockade and onset time after the initial 10 microg/kg of vecuronium were assessed, and doses required to exceed 90% blockade were recorded. In addition, effective doses of 50% and 95% for vecuronium were calculated from a single data point. Both types of MG patients showed increased sensitivity to vecuronium compared with non-MG patients. IMPLICATIONS: Hypothesizing that seronegative patients are as sensitive to vecuronium as seropositive patients, we assessed sensitivity in seropositive and seronegative myasthenia gravis (MG) patients and in non-MG patients. They were, indeed, both equally sensitive to vecuronium.