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.

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BackgroundThis study was done to evaluate the effect on pain relief when acetaminophen was added to lidocaine for intravenous regional anesthesia (IVRA).MethodsSixty patients undergoing hand or forearm surgery received IVRA were assigned to three groups: Group C received 0.5% lidocaine diluted with 0.9% normal saline to a total volume of 40 ml (n = 20), Group P received 0.5% lidocaine diluted with intravenous acetaminophen 300 mg to a total volume of 40 ml (n = 20) and Group K received 0.5% lidocaine diluted with 0.9% normal saline plus ketorolac 10 mg made up to a total volume of 40 ml (n = 20). Sensory block onset time, tourniquet pain onset time, which was defined as the time from tourniquet application to fentanyl administration for relieving tourniquet pain and amount of analgesic consumption during surgery were recorded. Following deflation of tourniquet sensory recovery time, postoperative pain and quantity of analgesic uses in post-anesthesia care unit were assessed.ResultsSensory block onset time was shorter in Group P compared to Group C (P < 0.05). Tourniquet pain onset time was delayed in Group P when compared with group C (P < 0.05). Postoperative pain and analgesic consumption were reduced in Group P and Group K compared to Group C (P < 0.001).ConclusionsThe addition of acetaminophen to lidocaine for IVRA shortens the onset time of sensory block and delays tourniquet pain onset time, but not with ketorolac. Both acetaminophen and ketorolac reduce postoperative pain and analgesic consumption.

The use of ketamine may be associated with the recall of unpleasant dreams after sedation. We hypothesized that a positive suggestion before sedation could reduce the incidence of ketamine-induced unpleasant dreams. To test this hypothesis, we randomized 100 patients receiving sedation with ketamine for their procedure into 2 groups with 1 group having an anesthesiologist provide a mood-elevating suggestion to the patient before ketamine administration (suggestion group), whereas in the control group no suggestion was provided. Patients were provided with a pleasantness/unpleasantness scale to rate "the overall mood of the dream" as very unpleasant (grade 1), quite unpleasant (grade 2), neither or mixed (grade 3), quite pleasant (grade 4), and very pleasant (grade 5). In those patients who lost consciousness, the frequencies of grades 1, 2, 3, 4, and 5 were 0%, 0%, 46%, 24%, and 30% in the suggestion group and were 6%, 2%, 70%, 12%, and 10%, respectively, in the control group (P=0.01). In the intent-to-treat population the overall frequency between groups was very similar. This study implies that when administering ketamine as part of a sedation regimen, positive suggestion may help reduce the recall of unpleasant dreaming.

Thoracic outlet syndrome has neurologic symptoms caused by compression of brachial plexus, blood vessel symptoms are caused by compression of the artery or vein. The authors report a case of sudden decrease in blood pressure of the left arm after turning the patient from supine position to prone position. They confirmed that the patient had thoracic outlet syndrome after performing computed tomography.

Background Changes in posture due to spinal anesthesia in instances of femur fracture can cause severe pain and stress in elderly patients. Dexmedetomidine (DEX) infusion is effective in preventing stress and inducing sleep, but DEX alone has limitations in controlling the pain caused by postural changes. To improve pain relief, we compared the analgesic effects of intravenous DEX–ketamine and DEX–fentanyl combinations to facilitate lateral positioning for spinal anesthesia in proximal femoral fractured patients. Methods Forty-six patients were randomly assigned to the group K or group F. Group K was intravenously given ketamine (1 mg/kg) for 10 minutes, while group F received intravenous fentanyl (1 mcg/kg) for 10 minutes. All patients in both groups received concomitantly a bolus of DEX 1 μg/kg over 10 minutes. Ten minutes after the administration of ketamine with DEX or fentanyl with DEX, patients were placed in the lateral position with the fracture site positioned up. Pain score and quality scores during spinal anesthesia (i.e., lateral positioning, hip flexion, and spinal block) were recorded. Results Pain scores during lateral positioning and hip flexion were significantly lower in group K than in group F (P < 0.0001). The quality scores of patients during all periods of spinal anesthesia were significantly lower in Group K than in Group F (P < 0.05). Hemodynamic parameters were not significantly different between the two groups. Conclusions Intravenous DEX–ketamine is a more effective combination of the lateral position for spinal anesthesia in patients undergoing surgery for proximal femoral fracture in comparison with intravenous DEX–fentanyl.

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.