A 76-year-old man with no notable medical history was scheduled for a robot-assisted radical prostatectomy. After the operation, he was given sugammadex. Two minutes later, ventricular premature contraction bigeminy began, followed by cardiac arrest. Cardiac arrest occurred three times and cardiopulmonary resuscitation was done. The patient recovered after the third cardiopulmonary resuscitation and was transferred to the intensive care unit. Coronary angiography was done on postoperative day 1. The patient was diagnosed with variant angina and discharged uneventfully on postoperative day 8.

ObjectiveA prospective, double-blind, randomized controlled trial to compare the effect of preoperative midazolam or ketamine on the incidence of emergence agitation (EA) following sevoflurane anaesthesia in children.MethodsPaediatric patients (2–6 years old) undergoing ophthalmic surgery were allocated to receive premedication with either 0.1 mg/kg midazolam or 1 mg/kg ketamine. Incidence of EA and postoperative pain scores were recorded at 10-min intervals in the postanaesthetic care unit (PACU). The use of EA rescue medications (fentanyl or midazolam) was recorded.ResultsThe incidence of EA was significantly lower in the ketamine group (n = 33) than the midazolam group (n = 34) at 10 and 20 min after transfer to PACU. There was no significant difference in overall incidence of EA. The frequency of midazolam use as rescue medication was significantly lower in the katamine group than in the midazolam group.ConclusionPremedication with ketamine is more effective than midazolam in preventing EA during the early emergence period after sevoflurane anaesthesia in children.

The PLEM100 (Inbody Co., Ltd., Seoul, Korea) is a device for measuring phase lag entropy (PLE), a recently developed index for the quantification of consciousness during sedation and general anesthesia. In the present study, we assessed changes in PLE along with the level of consciousness during the induction of general anesthesia using propofol. PLE was compared with the bispectral index (BIS), which is currently the most commonly used index of consciousness. After obtaining Institutional Review Board approval and written informed consent, we enrolled 15 patients (8 men, 7 women; mean age: 37 ± 9 years; mean height: 168 ± 8 cm; mean weight; 68 ± 11 kg) undergoing nasal bone reduction. PLE and BIS sensors were attached simultaneously, and general anesthesia was induced via target-controlled infusion (TCI) of propofol. PLE and BIS scores were recorded when the calculated effect site concentration shown on the TCI pump was equal to the target concentrations of 1.5, 2.0, 2.5, 2.8, 3.0, 3.2, 3.4, and 3.5 μg/mL (and at each 0.1 μg/mL increase, thereafter). Observer's Assessment of Alertness/Sedation (OAA/S) scores were also recorded until unconsciousness was achieved. Throughout the anesthesia period, all pairs of PLE and BIS data were collected using data acquisition software. The partial correlation coefficients between OAA/S scores and PLE, and between OAA/S scores and BIS were 0.778 ( P < .001) and 0.846 ( P < .001), respectively. Throughout the period of anesthesia, PLE and BIS exhibited a significant positive correlation. The partial correlation coefficient prior to the loss of consciousness was 0.838 ( P < .001), and 0.669 ( P < .001) following the loss of consciousness. Intra-class correlation between the 2 indices was 0.889 ( P < .001) and 0.791 ( P < .001) prior and following the loss of consciousness, respectively. PLE exhibited a strong and predictable correlation with both BIS and OAA/S scores. These results suggest that PLE is reliable for assessing the level of consciousness during sedation and general anesthesia.

Background Over the past few decades, interventional neuroradiology (INR) has been a rapidly growing and evolving area of neurosurgery. Sevoflurane and propofol are both suitable anesthetics for INR procedures. While the depth of anesthesia is widely monitored, few studies have examined the patient state index (PSI) during clinical neuroanesthesia. Objectives This study aimed to investigate the differences in PSI values and in hemodynamic variables between sevoflurane anesthetic and propofol anesthetic during INR procedures. Methods We reviewed the medical charts of the patients who underwent embolization of a non-ruptured intracranial aneurysm by a single operator at a single university hospital from May 2013 to December 2014. Sixty-five patients were included and divided into two groups: S group (sevoflurane anesthesia, n = 33) vs. P group (propofol anesthesia, n = 32). The PSI values, hemodynamic variables, and use of hemodynamic drugs between two groups were analyzed. Results There were significant differences between the PSI values obtained through different perioperative stages in the two groups (P < 0.0001). During the procedure, the PSI values were significantly lower in the P group than in the S group (P = 0.000). The P group patients had a more prolonged extubation time (P = 0.005) and more phenylephrine requirement than the S group patients (P = 0.007). More anti-hypertensive drugs were administered to the patients in the S group during extubation (P = 0.0197). Conclusions The PSI can be used to detect changes in anesthetics concentration and in the depth of anesthesia during INR procedures. Although the extubation was faster under sevoflurane anesthetic, propofol anesthetic showed rather smoother recovery.

Background:Medical researchers have been reluctant to use neuromuscular blocking drugs (NMBD) during the use of intraoperative motor evoked potential (MEP) monitoring despite the possibility of patient movement. In this study, we compared the effects of no NMBD and continuous rocuronium infusion on the incidence of patient involuntary movement and MEP monitoring.Methods:In this study, 80 patients who underwent neuro intervention with MEP monitoring were randomly assigned into 2 groups. After an anesthetic induction, bolus of rocuronium 0.1 mg/kg was injected when it was needed (for patient involuntary movement or at the request of the surgeon) in group B, and 5 mcg/kg/min of rocuronium were infused in group I study participants. The incidence of patient involuntary movement and spontaneous respiration, the mean MEP amplitude, coefficient of variation (CV), the incidence of MEP stimulus change and train-of-four (TOF) count were compared.Results:The incidence of involuntary movement and spontaneous movement were measured as significantly lower in group I (P < .05). The incidence of undetectable MEP did not differ as measured in both groups. The means and CVs of MEP amplitude in all limbs were significantly lower in group I. The mean TOF counts from 30 to 80 min of operation were significantly higher in group B.Conclusion:We conclude that the continuous infusion of rocuronium effectively inhibited the involuntary movement and spontaneous respiration of the patient while enabling MEP monitoring.