Sugammadex is belonging to a new class of drugs: the selective relaxant binding agents. Sugammadex can reverse residual paralysis by encapsulating free circulating non depolarizing muscle relaxants. The mains advantages of sugammadex when compared with conventional anticholinesterase agents are a much faster recovery time and the unique ability, for the first time, to reverse rapidly and efficiently deep levels of neuromuscular blockade. However it only works for reversal of rocuronium or vecuronium-induced neuromuscular blockade. When administered 3 min after rocuronium the use of a large dose (16 mg/kg) can even reverse rocuronium significantly faster than the spontaneous recovery after succinylcholine.
Cholinesterase Inhibitors ; Cyclodextrins ; Neostigmine ; Neuromuscular Blockade ; Neuromuscular Depolarizing Agents ; Paralysis ; Succinylcholine

Myasthenia Gravis is a chronic disorder of neuromuscular transmission characterized by weakness, fatigue of voluntary muscles, especially exacerbations and remissions, a rare disease in Korea. Special considerations are required in the anesthetic management of the myasthenic patients undergoing surgery under general anesthesia and in the postoperative respiratory management by anesthesi olgists. Authors report 8 cases of anesthesia, using N20-02-Enflurane without using nondepolarizing and depolarizing muscle relaxants for thymectomy, experienced during the year 1986~1990.
Anesthesia ; Anesthesia, General ; Fatigue ; Humans ; Korea ; Muscle, Skeletal ; Myasthenia Gravis ; Neuromuscular Depolarizing Agents ; Rare Diseases ; Thymectomy*

BACKGROUND: Malignant hyperthermia (MH) is a disorder of the skeletal muscle manifested as a life threatening hypermetabolic crisis in susceptible individuals following exposure to inhalation anesthetics and depolarizing muscle relaxants. The gold standard for determination of MH susceptibility is the in vitro contracture test (IVCT). However, it is invasive, requiring skeletal muscle biopsy and is not widely available. We attempted to reevaluate the MH in Korea using a Clinical Grading Scale (CGS) developed by Larach and colleagues to assist in clinical diagnosis. We intend to study CGS as a standardized means for estimating the qualitative likelihood of MH and establishing a Korean MH registry system. METHODS: We obtained twenty-seven case reports from the Korean Journal of Anesthesiology and applied a CGS developed by Larach and colleagues. The raw score of each case was obtained by scoring rules for the MH clinical grading scale, translated to a MH rank, and ranked by the MH likelihood. RESULTS: The overall mortality rate of reported MH was 44.4%. We described for MH rank and likelihood by CGS of cases. The CGS was missing a process in 13 cases for process II, 5 cases for process III and 4 cases for others. CONCLUSIONS: MH CGS is useful to aid the objective definition of this disease and for establishing a national registry system.
Anesthesiology ; Anesthetics, Inhalation ; Biopsy ; Contracture ; Korea ; Malignant Hyperthermia ; Muscle, Skeletal ; Neuromuscular Depolarizing Agents

BACKGROUND: Lidocaine is a useful local anesthetic and antiarrhythmic agent perioperatively. It may augment a neuromuscular block from both nondepolarizing and depolarizing muscle relaxants. Cisatracurium of benzylisoquinoline derivatives and rocuronium of aminosteroid derivatives are new nondepolarizing muscle ralaxants. We investigated interactions of cisatracurium or rocuronium with lidocaine in vitro. METHODS: Institutional approvement was obtained. Eighty male Sprague Dawley rats (150 - 200 g) were divided into 8 groups (control, lidocaine 1, 10 and 100microgram of both cisatracurium and rocuronium groups). The animals were anesthetized with phentobarbital 40 mg/kg I.P.. The hemidiaphragm with the phrenic nerve was dissected and mounted within 5 minutes in a bath containing 100 ml Kreb's solution at room temperature. The phrenic nerve was stimulated at supramaximal intensity by a Grass S88 stimulator through an SIU5 isolation unit. A twitch height was measured by a precalibrated Grass FT88 force displacement transducer and recorded with a Grass 79 polygraph. After stabilization of the twitch response, cisatracurium (50microgram), and rocuronium (100microgram) were added to the Kreb's solutions. After 10 minutes, we measured twitch height, and saline 1 ml or lidocaine 1, 10 or 100microgram was added to the Kreb's solution. After 10 minutes, we again measured twitch responses. The data was analyzed by repeated measures of ANOVA. RESULTS: There were significant depressions in the twitch response of cisatracurium in lidocaine 10microgram and 100microgram groups compared with the control group and lidocaine 1microgram group. In addition, the lidocaine 100microgram group was significantly depressed compared with the lidocaine 10microgram group. There were no significant depressions of the twitch response of rocuronium in lidocaine 1microgram, 10microgram, and 100microgram groups compared with the control group. CONCLUSIONS: We concluded that lidocaine will increase the sensitivity to cisatracurium in the hemdiaphragm preparation of rats. Lidocaine will be able to cause recurarization. There was not a statistically significant change in the rocuronium group but it was clinically significant.
Animals ; Baths ; Depression ; Humans ; Lidocaine* ; Male ; Neuromuscular Blockade* ; Neuromuscular Depolarizing Agents ; Phrenic Nerve ; Poaceae ; Rats ; Rats, Sprague-Dawley ; Transducers

BACKGROUND: Lidocaine is useful as a local anesthetic and antiarrhythmic agent perioperatively. It may augment a neuromuscular block from both nondepolarizing and depolarizing muscle relaxants. Cisatracurium is a new muscle relaxant as an isomer of atracurium. We investigated the interaction of cisatracurium and lidocaine on the dose-response curve in vitro. METHODS: Institutional approvement was obtained. Forty male Sprague-Dawley rats (150 - 200 gm) were divided into four groups (control, lidocaine 0.01, 0.1, or 1ng/ml). The animals were anesthetized with 40 mg/kg pentobarbital. The hemidiaphragm with the phrenic nerve was dissected and mounted within 5 minutes in a bath containing 100 ml Kreb's solution at 32degreesC. The phrenic nerve was stimulated at supramaximal intensity by a Grass(R) S88 stimulator through an SIU5 isolation unit. A twitch height was measured by a precalibrated Grass FT88 force displacement transducer and recorded with a Grass 79 polygraph. After stabilization of the twitch response, cisatracurium was added to the solution to obtain an initial concentration of 50ng/ml with saline 1 ml or lidocaine 0.01, 0.1 or 1ng/ml. When a stable 3 - 5 twitch inhibition was obtained after the first dose, additional cisatracurium was added to the Kreb's solution in increments of 25ng/ml to more than a 90% neuromuscular block. The data was analyzed by repeated measures of ANOVA. RESULTS: There was a significant decrease in the effective dose of cisatracurium needed to depress the twitch response in lidocaine 0.1ng/ml and 1ng/ml groups compared with the control group and with the lidocaine 0.01ng/ml group. CONCLUSIONS: We concluded that lidocaine will increase the sensitivity to cisatracurium in the hemidiaphragm preparation of rats.
Animals ; Atracurium ; Baths ; Humans ; Lidocaine* ; Male ; Neuromuscular Blockade ; Neuromuscular Depolarizing Agents ; Pentobarbital ; Phrenic Nerve ; Poaceae ; Rats ; Rats, Sprague-Dawley ; Transducers

Malignant hyperthermia (MH) may lead to metabolic crisis of skeletal muscle in susceptible individuals following exposure to triggering agents such as volatile anesthetics or depolarizing muscle relaxants. MH is a rare and a potentially lethal disease, which can lead to cardiac arrest. We report a case of severe MH, in which the rapidly evolving signs of hypermetabolism eventually resulted in cardiac arrest. Despite conventional treatments following cardiopulmonary resuscitation, the patient's vital signs did not improve. Therefore, we applied extracorporeal membrane oxygenation for providing hemodynamic support.
Anesthetics ; Cardiopulmonary Resuscitation* ; Dantrolene ; Extracorporeal Membrane Oxygenation* ; Heart Arrest* ; Hemodynamics ; Humans ; Malignant Hyperthermia* ; Muscle, Skeletal ; Neuromuscular Depolarizing Agents ; Vital Signs

Malignant hyperthermia (MH) is an inherited disorder of skeletal muscle manifested as a life threatening hypermetabolic crisis in susceptible individuals following exposure to commonly used inhaled anesthetics and depolarizing muscle relaxants. We experienced a suspicious case of MH in 34-year-old male during transfemoral cerebral angiography embolization under general anesthesia with desflurane. The episode emerged 15 minutes after induction of general anesthesia using propofol, rocuronium, remifentanil, desflurane. Desflurane is a recently developed inhaled anesthetics and there has been no case report of MH related with it in Korea. When we suspected episode, vigorous treatment was carried out, symptoms were resolved without dantrolene administration.
Androstanols ; Anesthesia, General ; Anesthetics ; Cerebral Angiography ; Dantrolene ; Humans ; Isoflurane ; Korea ; Male ; Malignant Hyperthermia ; Muscle, Skeletal ; Neuromuscular Depolarizing Agents ; Piperidines ; Propofol

Paramyotonia congenita is a rare hereditary skeletal muscle disease characterized by exercise- or cold-induced myotonia. Anesthesiologists should make any efforts to prevent perioperative myotonic attack and muscle weakness in patients with this kind of disorder. Specifically, the administration of depolarizing muscle relaxants should be avoided and serum potassium level as well as body temperature should be carefully managed. The present report describes our experiences with successful epidural anesthesia in a patient with paramyotonia congenita who underwent a lumbar discectomy.
Analgesia, Epidural ; Anesthesia, Epidural* ; Body Temperature ; Diskectomy* ; Humans ; Muscle Weakness ; Muscle, Skeletal ; Myotonia ; Myotonic Disorders* ; Neuromuscular Depolarizing Agents ; Potassium

Malignant hyperthemia is an autosomal-dominant inherited disorder of the skeletal muscle cell charac terized by a hypermetabolic response to all commonly used inhalational anesthetics and depolarizing muscle relaxants. The clinical syndrome includes muscle rigidity, hypercapnia, tachycardia and myoglobinuria as result of increased carbon dioxide production, oxygen consumption and muscle membrane breakdown. Early recognition and vigorous treatment are very important factors to determine patient's prognosis in malignant hyperthermia. However, it is very difficult to diagnose malignant hyperthermia during anesthesia because malignant hyperthermia presents with multiple nonspecific signs and laboratory findings of variable intensity and time course during and after exposure to anesthetic agents. We report a case of malignant hyperthermia which was diagnosed early using capnography before the appearance of hyperthermia and successfully treated. The malignant hyperthermia episode developed 20 minutes after induction of anesthesia with thiopental sodium, pancuronium, isoflurane, N2O and O2. When we suspected episode, we could not observe any classical signs of malignant hyperthermia except unexplained tachycardia and elevated end-tidal CO2. We discuss here the usefulness of capnography in early recognition of malignant hyperthermia and the importance of early recognition in prognosis.
Anesthesia ; Anesthetics ; Capnography* ; Carbon Dioxide ; Fever ; Hypercapnia ; Isoflurane ; Malignant Hyperthermia* ; Membranes ; Muscle Rigidity ; Muscle, Skeletal ; Myoglobinuria ; Neuromuscular Depolarizing Agents ; Oxygen Consumption ; Pancuronium ; Prognosis ; Tachycardia ; Thiopental

Efforts from various approaches have been made to anesthetize myasthenic patients associated with thymoma and, on a ehoice of kinds and dosage of the muscle relaxants, there were considerable solicitude of the anesthesiologist. In recent years, intermediate aeting none depolarizing muscle relaxants were developed and its use tends to increase. we used with the divided dose administration of small amount vecuronium and observed the degree of relaxation using peripheral nerve stimulator for endotracheal intubation and maintenance of anesthesia. On the basis of our experience, we would like to recommand techniques that administrate the divided dose of small amount vecuronium as a musde relaxant and use peripheral nerve stimulator during general anesthesia.
Anesthesia ; Anesthesia, General ; beta-Aminoethyl Isothiourea ; Humans ; Intubation, Intratracheal ; Myasthenia Gravis* ; Neuromuscular Depolarizing Agents ; Peripheral Nerves ; Relaxation ; Thymectomy* ; Thymoma* ; Vecuronium Bromide