rocuronium and Spinal-Fractures

Pediatric laryngotracheal injuries from blunt neck trauma are extremely rare, but can be potentially catastrophic. Early diagnosis and skillful airway management is critical in avoiding significant morbidity and mortality associated with these cases. We present a case of a patient who suffered a complete tracheal transection and cervical spine fracture following a clothesline injury to the anterior neck. A review of the mechanisms of injury, clinical presentation, initial airway management, and anesthetic considerations in laryngotracheal injuries from blunt neck trauma in children are presented.

Topics: Androstanols; Anesthetics, Intravenous; Child; Fentanyl; Humans; Intubation, Intratracheal; Laryngoscopy; Larynx; Male; Midazolam; Neuromuscular Nondepolarizing Agents; Radiography; Rocuronium; Spinal Fractures; Trachea; Tracheostomy; Wounds, Nonpenetrating

We present the first case of a patient with severe aortic stenosis who developed anaphylactic shock and was successfully treated with adrenaline and landiolol, a highly selective β1-receptor blocker, to prevent disruption of the myocardial oxygen supply-demand balance caused by tachycardia.. An 86-year-old woman was scheduled for simultaneous anterior-posterior fixation for a burst fracture of the 12th thoracic vertebra; 200 mg sugammadex, a neuromuscular blocking agent antagonist, was administered postoperatively, and she was extubated without complications. However, 6 min after extubation, her blood pressure decreased abruptly to 55/29 mm Hg, and her heart rate increased to 78 bpm. Then, we intervened with fluid loading, an increased dose of noradrenaline, and phenylephrine administration. However, her blood pressure did not increase.. A general observation revealed urticaria on the lower leg; thus, we suspected anaphylactic shock due to sugammadex administration.. We carefully administered 2 doses of 0.05 mg adrenaline and simultaneously administered landiolol at 60 μg/kg/min to suppress adrenaline-induced tachycardia. Adrenaline administration resulted in a rapid increase in blood pressure to 103/66 mm Hg and a maximum heart rate of 100 bpm, suppressing excessive tachycardia.. The patient's general condition was stable after the intervention, and circulatory agonists could be discontinued the following day. She was discharged from the intensive care unit on the fourth postoperative day.. Landiolol may help control the heart rate of patients with aortic stenosis and anaphylactic shock. The combined use of landiolol and adrenaline may improve patient outcomes; however, their efficacy and risks must be evaluated by studying additional cases.

Topics: Adrenergic beta-Agonists; Adrenergic beta-Antagonists; Aged, 80 and over; Anaphylaxis; Aortic Valve Stenosis; Echocardiography; Epinephrine; Female; Humans; Morpholines; Postoperative Complications; Rocuronium; Spinal Fractures; Sugammadex; Urea

We present a case in which rocuronium was applied for muscle relaxation following the administration of sugammadex. An emergency surgery under general anesthesia was planned for a 43-year-old male patient due to an L1 vertebral corpus and right tibia-fibula shaft fracture. Anesthesia was induced with fentanyl, propofol and lidocaine. After applying only 30mg of the total induction dose of rocuronium, it was learned that the neurological examination should be controlled again from the surgeon because of the controversial of the neurological deficit. As a result, patient awakened from anesthesia. We administered 2mg/kg sugammadex and spontaneous breathing of patient returned immediately. The patient became conscious and orientated immediately afterwards. The neurological examination of the lower extremities was performed. The patient was anesthetized once again and 0.6mg/kg rocuronium was given in order to gain neoromuscular block approximately 10min after sugammadex administration. 2min later, the patient was smoothly intubated. Neuromuscular monitorization was not used because of emergency. We administered 2mg/kg sugammadex at the end of the procedure and the patient was extubated. The most suitable time for the re-establishment of rocuronium following sugammadex is currently unclear. This case showed that neuromuscular block can be effectively re-induced by rocuronium following the reversal of rocuronium-induced neuromuscular block with sugammadex. In this case, we consider that the ability to effectively reuse normal induction doses of rocuronium is an important clinical observation.

Topics: Accidental Falls; Adult; Androstanols; Anesthesia, General; gamma-Cyclodextrins; Humans; Intraoperative Awareness; Lumbar Vertebrae; Male; Muscle Relaxation; Neuromuscular Blockade; Neuromuscular Nondepolarizing Agents; Rocuronium; Spinal Fractures; Sugammadex; Tibial Fractures