These results demonstrate the existence of a cross-talk between the nitrate-nitrite-NO pathway and the NOS-dependent pathway in control of vascular NO homeostasis.

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Background: Intraoperative neuromonitoring (IONM) might reduce the incidence of injury to the recurrent laryngeal nerve (RLN) during thyroidectomy. Although dislocation of endotracheal tube surface electrodes can lead to false-positive IONM results (loss of signal), the risk factors for dislocation and the effects of muscle relaxants are unclear. Therefore, to identify factors that affect IONM results, we examined the frequency and risk factors for tube dislocation after cervical extension before surgery, the effect of sugammadex administration, and the correlation between IONM results and postoperative RLN palsy. Methods: Thirty-nine patients scheduled for thyroidectomy from October 2016 to April 2017 were enrolled. All patients underwent standard IONM and pre-and postoperative laryngoscopy. Differences in patient characteristics in the tube dislocation group and non-dislocation group, and differences in amplitude during vagal stimulation before and after sugammadex administration, were assessed by the Mann-Whitney test or Fisher's exact test. Results: Tube dislocation occurred in 27 patients (69%). Sterno-cricoid distance was significantly shorter in the dislocation group (n=27) than in the non-dislocation group (n=12) (43.88 [32.2-55.91] mm vs 49.46 [40.66-55.91] mm, respectively; p=0.048). Without sugammadex, amplitude during vagal stimulation was sufficient for monitoring. Nine patients had new-onset RLN palsy, which was transient in all patients. The sensitivity of IONM was 100%, the positive predictive value was 60%, and the negative predictive value was 100%. Conclusions: The present findings suggest that anesthesiologists should use video laryngoscopy to correct tube dislocation and that a rocuronium dose of 0.6 mg/kg, without sugammadex, is adequate for

Deafferentation pain induced by subarachnoid block (SAB) is rare, but it can appear in the form of recurrent phantom lower limb pain, new acute-onset stump pain in amputees, lower limb pain in patients with tabes dorsalis, and neuropathic pain. We have previously reported that thiopental is an effective treatment for deafferentation pain induced by therapeutic SAB applied to treat neuropathic pain of central origin. Here, we report the case of an amputee who developed new stump pain in his lower limb immediately after subarachnoid tetracaine was administered prior to appendectomy. A 51-year-old man who had previously undergone right below-knee amputation for acute arterial thrombosis, and who had not previously experienced chronic phantom limb or stump pain, was scheduled for emergency open appendectomy. For anesthesia, we induced SAB with a hyperbaric tetracaine solution. No paresthesia occurred during administration. However, the patient immediately complained of severe, lightning-bolt pain in the right lower limb stump after the SAB was established. He was given intravenous pentazocine, which promptly resolved the pain. Appendectomy was then performed under sedation using intravenous midazolam. The patient did not experience further deafferentation pain during his hospital stay and has reported no stump pain since discharge from the hospital. This case report suggests that SAB induces deafferentation pain in some patients and that this unusual pain can be treated with pentazocine. (J Nippon Med Sch 2017; 84: 183 185)