This 22 years-old male under went spinal fusion for correction of a servere Thoraco-Lumbar Scoliosis (Cobb's angle at 65o (degree) under general anesthesia with O2-Sevoflurane (1-2 vol%),Atracurium (0.3 mg.kg-1.hr-1,) Dexmedetomidine (0.4 ug,kg-1.hr-1,). With discontinuation of Atracurium infusion 30 minutes and Sevoflurane 15 minutes before ake-up test, the patient was able to mov both feet on command with only Dexmedetomidineinfusion running. Upon establshing intact neurological function, the level of anesthesia as deepened using Propofol 50mg/IV, Atracurium 20mg/IV and Fentanyl 50 ug,/IV. Coorective spine surgery with pedicle rod and screw instrumentation, spinal fusion with iliac bone grafting was then continued and completed under Dexmedetomidine 0.2-2.4 ug.kg-1.hr-1, and O2-Sevoflurane at 1 vol%. Dexmedetomidine insusion was continued at 0.2 ug.kg-1.hr-1, at the Post-Anesthesia Care Unit. Postoperative course was likewise unremarkable with no recall of intra-operative events.
Human ; Male ; Young Adult ; DEXMEDETOMIDINE ; SCOLIOSIS ; SPINAL FUSION ; SPINAL CORD

The effects of three different intubating doses of vecuronium were investigated using the refined priming principle. Sixty patients were studied. Twenty patients were each allocated randomly into three groups I, II, and III and received 0.12, 0.15, and 0.20 mg/kg intubating dose of vecuronium respectively. The priming dose of 0.01 mg/kg and the priming interval of 4 minutes were the same for all groups. The degree of neuromuscular block were determined by the train-of-four (TOF) ratios with the use of the TOF-GUARD nerve stimulator. Onset time (from injection of the intubating dose to 95% and 100% suppression of the TOF), clinical duration (return of the first twitch from maximum block to 25% of the TOF), and intubation conditions were determined. The onset time to 95% and 100% of the TOF were significantly shorter as the intubating dose of vecuronium were increased (at 0.12 mg/kg, onset was 151 +/- 15s; at 0.15 mg/kg, onset was 97 +/- 16s; and at 0.20 mg/kg, onset was 69 +/- 10s). The clinical duration was significantly increased between group I (60 +/- 11 min) and both groups II (77 +/- 15 mm) and III (74 +/- 17 mm), but not significant between groups II and III. The changes in the heart rate and mean arterial pressure in all groups were not significant. In conclusion, a priming dose of 0.01 mg/kg followed by a larger intubating dose (0.20 mg/kg) four minutes later provides an excellent intubation condition within 69 +/- 10s with no clinically significant hemodynamic changes. (
Human ; Middle Aged ; Adult ; Young Adult ; Adolescent ; MYOCARDIAL ISCHEMIA ; SURGERY ; VECURONIUM BROMIDE ; NEUROMUSCULAR BLOCKADE ; NEUROMUSCULAR AGENTS