rocuronium and Femoral-Neck-Fractures

We report a successful management of anesthesia in a 55-year-old male patient with spinal and bulbar muscular atrophy (SBMA). His respiratory and swallowing functions were preserved preoperatively. He underwent an osteosynthesis for a femoral neck fracture under general anesthesia using nondepolarizing muscle relaxant. The anesthetic concerns in patients with SBMA are the possibility of postoperative respiratory dysfunction due to anesthetics or muscle relaxants and that of postoperative neurological deterioration due to spinal or epidural anesthesia. In this case, the effect of an intubating dose of rocuronium (0.5 mg · kg(-1)) was markedly prolonged, but it was completely reversed by sugammadex (2 mg · kg(-1)). Postoperative course was uneventful and clinical symptoms of SBMA did not become exacerbated.

Topics: Androstanols; Anesthesia, Epidural; Anesthesia, General; Drug Combinations; Femoral Neck Fractures; Fracture Fixation, Internal; gamma-Cyclodextrins; Humans; Male; Middle Aged; Muscular Atrophy, Spinal; Muscular Disorders, Atrophic; Neuromuscular Nondepolarizing Agents; Rocuronium; Sugammadex

An 86-year-old woman was scheduled to receive fourth reconstructive surgery for femoral bone fracture under general anesthesia. She had been suspected with narrow angle glaucoma due to headache and bloodshot eyes during gastroscopy. During transfer to our hospital, she fell down and suffered from the right femoral neck fracture. The patient underwent femoral head replacement under spinal anesthesia. Later, she received surgeries twice uneventfully under spinal anesthesia; removal and re-implantation of the femoral bone head due to infection of the implanted head. Six months later, she fell down again and femoral bone was fractured during rehabilitation. Anesthesia was induced with propofol followed by rocuronium 0.9 mg x kg(-1) i.v. Anesthesia was maintained with propofol and remifentanil, and rocuronium was administered to maintain PTC of 10 or less. The surgery was completed in 150 minutes. At the end of surgery, a laryngeal mask was inserted and the tracheal tube was removed. TOF ratio recovered to 80% 8 minutes after sugammadex 2 mg kg(-1) i.v., and increased to 100% 3 minutes after additional 1 mg x kg(-1). Intraocular pressure stayed below 20 mmHg during the intervention. We could achieve full reversal of neuromuscular blockade and suppress increase in intraocular pressure with use of sugammadex.

Topics: Aged, 80 and over; Androstanols; Anesthesia, Spinal; Arthroplasty, Replacement, Hip; Female; Femoral Neck Fractures; gamma-Cyclodextrins; Glaucoma, Angle-Closure; Humans; Laryngeal Masks; Rocuronium; Sugammadex

A 44 year old woman with a severe drug induced tardive dyskinesia had previously been treated with a left thalamotomy and right deep brain stimulation. Thalamotomy abolished the right hemiballismus. Deep brain stimulation caused a moderate reduction of the remaining involuntary movements on the left side. After a minor orthopaedic operation under general anaesthesia, the dyskinesia disappeared completely, even with the deep brain stimulation turned off. The remission has now lasted for 41 months.

Topics: Adult; Androstanols; Anesthetics, General; Antipsychotic Agents; Brain; Dyskinesia, Drug-Induced; Female; Femoral Neck Fractures; Fentanyl; Flupenthixol; Humans; Isoflurane; Neurosurgical Procedures; Receptors, Dopamine; Remission Induction; Rocuronium; Thalamus; Thiopental