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This is the first study to use microarray analysis with confirmatory qRT-PCR to identify altered genes after vein bypass grafting. Oligonucleotide microarrays and hierarchical clustering are powerful tools to generate hypotheses as the basis for additional research on gene expression in vein graft remodeling. Ultimately, identification of a temporal sequence of differential gene expression may provide insights not preferred into the molecular mechanisms of vein graft remodeling, but also into the pathways leading to intimal hyperplasia.

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Introduction: Induction of anesthesia relies on multiple factors including appropriate monitoring, administration, and dosing of induction agents. In morbidly obese patients, placement and maintenance of intravenous lines may be difficult and accidental subcutaneous infiltration of medications may be challenging to identify. The treatment of accidental subcutaneous administration of neuromuscular blocking agents may be complex as the absorption and subsequent elimination is altered and not well known, and the inadvertent prolonged dosing could lead to catastrophic complications. Case Report: We present a case report of the successful management of the accidental subcutaneous administration of rocuronium in a morbidly obese, 65-year-old Caucasian female with multiple comorbidities undergoing an elective endovascular procedure. The perioperative management of the patient is discussed, and a review of the literature is provided. Conclusion: Relatively little information is available regarding the absorption of medications outside of the typical route of administration. The accidental subcutaneous infiltration of neuromuscular blockers could lead to airway compromise or prolonged blockade due to the unknown onset, peak effect, and duration of action. Open discussion among the many treatment team members after identification of accidental misadministration of medications is critical and clinical acumen is paramount to ensure optimal patient outcomes. Since intravenous line infiltration and subsequent subcutaneous extravasation are not a rare intraoperative event, more research into the effects of neuromuscular blocking agents is needed to aid clinical outcomes. Keywords: Anesthesia, critical care, drug administration routes, extravasation, neuromuscular blocker.