Baseline TOF ratios measured by AMG are usually more than 1.0 and vary widely among patients. Therefore a TOF ratio of 0.9 displayed postoperatively on AMG does not always represent adequate recovery of neuromuscular function and should be normalized by baseline value to reliably detect residual paralysis.

A lthough chronological age is a well-established risk factor for developing cardiovascular diseases, the changes that accumulate with age are highly variable. It has been increasingly recognized that indices of vascular age are more reliable than age per se in prediction of adverse cardiovascular outcomes. Variations in the way these age-related changes occur are a function of many genetic and environmental factors. Some of the pathophysiological mechanisms that characterize the vascular aging phenotype are reviewed, and an overview of the key outcome studies that deal with the value of these vascular health indicators is provided, as well as a discussion of the potential effects on perioperative cardiovascular outcomes. COMMENTDespite an expanding number of effective preventive measures and treatments for such cardiovascular risk factors as hypertension and hypercholesterolemia, cardiovascular disease attributable to aging remains the leading cause of mortality in Western countries. This seeming incongruity results from the reality that age itself is associated with morphological changes in all layers of the vascular tree, including central aortic dilation and thickening of the arterial wall even in the absence of atherosclerotic disease. Functional changes occur as well in the vasculature, and the rate at which these morphological and functional alterations develop is characteristic by enormous interindividual variation. The great physician William Osler demonstrated extraordinary insight when, more than a century ago, he proclaimed, BYou are as old as your arteries.[ Increased arterial stiffness is a direct manifestation of early vascular aging and is accompanied by increased central aortic pressure. Current data imply that aortic pulse wave velocity and augmentation index are the best available noninvasive approximations of arterial stiffness in patients older than and younger than 50 years, respectively. Pulse wave velocity is calculated as the distance (femoral-carotid) divided by time, as derived from the electrocardiogram. These values are more sensitive than traditional risk factors at predicting cardiovascular outcomes. Emerging data have linked increased pulse pressure with stroke, renal failure, and mortality after cardiac surgery, thereby offering evidence that measures of vascular stiffness may yield important information in terms of risk stratification. Moreover, data indicate that blood pressureYreducing therapies specifically targeted to lowering central aortic pressure may offer additional therapeutic advantages in routine clinical practice beyond their basic blood pressureYreducing effects. Whether interventions focused on reducing central aortic pressure can ameliorate the risk for indi-viduals undergoing cardiac and noncardiac surgery is yet to be determined. Comment by Kathryn E. McGoldrick, MD Disclosure: The authors declare no conflict of interest.T he reversibility of rocuronium-induced profound neuromuscular block with sugammadex in younger and older patients was compared. Fifteen young...

Sugammadex 4 mg/kg was required to reverse a moderate rocuronium-induced neuromuscular block when the corrugator supercilii muscle is used for monitoring.

No abstract

Sugammadex can adequately restore neuromuscular function in older patients, although a longer time is required to recover from profound rocuronium-induced neuromuscular block than in younger patients.

Tactual evaluation of muscle paralysis of the MM during induction of anesthesia is clinically useful since it leads to faster tracheal intubation.

Subjective evaluation of contractions of the MM by an anesthesiologist's hand may be reliable to determine faster timing for safe tracheal intubation.

Pancreatic ductal adenocarcinoma (PDAC) is an aggressive cancer with a poor prognosis. Patients with inoperative PDAC require effective chemotherapy and pain control to increase their quality of life. We investigated whether duloxetine, a serotonin–noradrenaline reuptake inhibitor, improves quality of life in a KPPC (LSL-Kras G12D/+ ;Trp53 flox/flox ;Pdx1-cre) mouse model of PDAC. Six-week-old KPPC mice were orally administered 4 mg/kg/d duloxetine (n = 12); 4 mg/kg/d duloxetine with 0.15 mg/kg/d atipamezole, a synthetic α2 adrenergic receptor antagonist (n = 9); or vehicle water (n = 11). Body weight and food intake were measured daily, and cancer pain was evaluated by the hunching score and mouse grimace scale. At the endpoint, the tumor status, angiogenesis, and immunoinflammatory condition were analyzed. The pain level using the hunching and mouse grimace scale scores improved by duloxetine in KPPC mice (P < 0.01), whereas the scores that had been reduced by duloxetine were elevated by administration of atipamezole. Kaplan–Meier analysis demonstrated that duloxetine-treated mice had significantly prolonged survival (P < 0.05) with delayed appetite loss, cachexia, and body weight loss. Duloxetine inhibited the proliferation of PDAC cells and cancer-associated fibroblasts in vivo with a shift into an antitumor immunoinflammatory condition and the corresponding plasma cytokine levels. The migrative/invasive potentials of PDAC were inhibited by duloxetine in vitro. Meanwhile, atipamezole did not inhibit the antitumor effects of duloxetine in vitro and in vivo. Therefore, our results indicate that duloxetine mainly improves cancer-associated pain by enhancement of the noradrenergic pathway rather than the serotonergic pathway, whereas duloxetine modulates antitumor effects on PDAC without involvement of the noradrenergic pathway.