Arnold-Chiari malformation is a group of deformities seen in the hindbrain that is cerebellum, pons, and medulla oblongata. Based on the morphology of the malformations as seen radiologically or during an autopsy, Chiari II includes brainstem, fourth ventricle, and greater than 5 mm descent of the caudal tip of cerebellar tonsils past the foramen magnum with spina bifida. In the present case, a report of anesthetic management of a 29-year-old school clerk presented with hydrocephalus and myelomeningocele and MR imaging revealed herniation of cerebellum and medulla through foramen magnum, hence, confirming it to be a case of type II Chiari malformation posted for ventriculoperitoneal shunting and foramen magnum decompression.
BACKGROUND: Sugammadex is a modied γ-cyclodextrin, “SU” stands for sugar and “gammadex” stands for structural molecule
gamacyclodextrin. It can reverse profound neuromuscular blockade and can be given for immediate reversal without waiting for the natural
recovery. In a dose of 1.0 mg/kg. It can reverse Rocuronium-induced neuromuscular block which has spontaneously recovered to a train-of-four
count of four. In this prospective single arm interventional clinical study, we investigated whether 1mg/kg of Sugammadex can also reverse
Vecuronium induced neuromuscular blockade at a similar level of block.
METHODS: Thirty one patients of 18-70 years of age who were scheduled to undergo general surgery and gynaecological procedures were
enrolled. All patients received standard general anaesthesia with propofol, sevourane, fentanyl, and vecuronium. Neuromuscular function was
monitored with acceleromyography (Stimupod xavant technology. Hague, Netherlands). Once the neuromuscular function recovered
spontaneously to four twitches in response to train-of-four stimulation, patients were administered 1 mg/kg of Sugammadex I.V. Time from study
drug injection to normalized train-of-four ratio 0.9 and the incidence of incomplete reversal within 30min were the primary outcome variables.
Secondary outcome was the incidence of reparalysis with normalized train-of-four ratio less than 0.9.
RESULTS: We observe that at 0 min, less than 5 percent had complete recovery of neuromuscular function, while at 5th minute, almost 97% of
patients had complete recovery which maximizes to 100 percent in 15 minutes. The same total recovery is maintained until 30 minutes without any
reparalysis.
CONCLUSIONS: Sugammadex in a dose of 1.0mg/kg, reversed a threshold train-of-four count of four in vecuronium induced neuromuscular
block without any reparalysis.
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