rocuronium and Thymus-Neoplasms

The use of neuromuscular blocking agents is still controversial in myasthenic patients but rocuronium could be useful after the introduction of sugammadex as a selective antagonist. The aim of the study was to evaluate the use of rocuronium-sugammadex in myasthenic patients undergoing thoracoscopic thymectomy.. After ethical approval, 10 myasthenic patients undergoing videothoracoscopic-assisted thymectomy were enrolled in the study. Neuromuscular block was achieved with 0.3 mg/kg rocuronium and additional doses were given according to train-of-four (TOF) monitoring or movement of the diaphragm. Sugammadex 2 mg/kg was given after surgery. Recovery time (time to obtain a TOF value > 0.9) was recorded for all subjects.. All patients were extubated in the operating room after administration of sugammadex. Mean rocuronium dose was 48 mg and the average operation time was 62 min. Recovery time after sugammadex administration was 111 s (min 35; max 240).. A rapid recovery of neuromuscular function was found in myasthenic patients receiving rocuronium when sugammadex was used for reversal. This combination could be a rational alternative for myasthenic patients for whom neuromuscular blockade is mandatory during surgery.

Topics: Adult; Androstanols; Anesthesia Recovery Period; Cholinesterase Inhibitors; Elective Surgical Procedures; Female; gamma-Cyclodextrins; Humans; Male; Myasthenia Gravis; Neuromuscular Blockade; Neuromuscular Monitoring; Neuromuscular Nondepolarizing Agents; Pyridostigmine Bromide; Rocuronium; Severity of Illness Index; Sugammadex; Thoracic Surgery, Video-Assisted; Thymectomy; Thymoma; Thymus Neoplasms

In spinocerebellar degeneration (SCD) patients, general and regional anesthesia may cause postoperative dysfunction of respiratory, nerve and muscle systems. We present the surgical case of thymoma developed in patient with SCD.. A 47-year-old woman with spinocerebellar degeneration was admitted because of a well-defined mass measuring 48 × 31 mm in anterior mediastinum. She showed limb, truncal, ocular, and speech ataxia; hypotonia; areflexia; sensory disturbances; and muscle weakness. Her eastern cooperative oncology group performance status was 4. Surgical resection was performed via video-assisted thoracic surgery and under general anesthesia only without epidural analgesia. The mass was diagnosed as type B1 thymoma without capsular invasion (Masaoka stage I). The patients got a good postoperative course by cooperation with anesthesiologists and neurologists in perioperative managements. She has been well over 3 years of follow-up.. In conclusion, careful surgical and anesthesia management is essential for providing an uneventful postoperative course in patients with SCD. Especially, selection of minimal invasive approach and avoid diaphragmatic nerve damage are the most important points in surgical procedures.

Topics: Analgesics, Opioid; Anesthesia, General; Anesthetics, Intravenous; Female; Humans; Middle Aged; Neuromuscular Nondepolarizing Agents; One-Lung Ventilation; Propofol; Remifentanil; Rocuronium; Spinocerebellar Degenerations; Thoracic Surgery, Video-Assisted; Thymectomy; Thymoma; Thymus Neoplasms

Stiff-person syndrome is an uncommon disease characterized by muscular rigidity and painful spasms in the axial and limb muscles. We report a 58-year-old woman with stiff-person syndrome undergoing thymectomy under general anesthesia. Before surgery, her medications were 25 mg of diazepam, 2 mg of clonazepam, and 15 mg of gabapentin per day. After epidural catheterization for the postoperative analgesia, general anesthesia was induced and maintained with continuous remifentanil infusion and propofol with target controlled infusion. With train-of-four ratio (TOFR) monitoring by stimulating the ulnar nerve, her trachea was intubated after 0.6mg x kg(-1) of rocuronium intravenous administration. Since then, additional rocuronium was not given for 4 hours. After surgery, she was fully awake and TOFR recovered to 100%, but tidal volume was too low to remove the tracheal tube, and mechanical ventilation was continued in ICU. On the next day, the tracheal tube was removed, and she was discharged from ICU. Because anesthetics may delay the recovery of respiratory function in a patient with stiff-person syndrome, careful assessment of respiratory function is needed at the emergence from general anesthesia.

Topics: Airway Extubation; Airway Management; Androstanols; Anesthesia, General; Female; Humans; Middle Aged; Rocuronium; Stiff-Person Syndrome; Thymectomy; Thymus Neoplasms

Thymectomy continues to be the treatment of choice for certain patients with myasthenia gravis. As surgical techniques have developed, anesthesiologists have considered the need to adapt anesthetic techniques to improve care of patients undergoing this procedure. We describe the anesthetic management of 2 patients undergoing thymectomy performed with a bilateral thoracoscopic approach. Because it is best to avoid the use of opiates during and after surgery, we performed a bilateral paravertebral thoracic block, inserting the catheters into the paravertebral space on each side to infuse local anesthetics on either side as needed as the operation progressed. Surgery was completed without adverse events and tubes were removed from the tracheas of both patients at the end of the procedures. Bilateral continuous infusion of local anesthetics provided satisfactory analgesia on the following days.

Topics: Adult; Analgesia; Androstanols; Anesthesia, Inhalation; Anesthetics, Local; Combined Modality Therapy; Contraindications; Dose-Response Relationship, Drug; Female; Humans; Methyl Ethers; Myasthenia Gravis; Nerve Block; Neuromuscular Nondepolarizing Agents; Pain, Postoperative; Pyridostigmine Bromide; Rocuronium; Sevoflurane; Thoracic Surgery, Video-Assisted; Thymectomy; Thymoma; Thymus Neoplasms

Topics: Androstanols; Anesthesia Recovery Period; Half-Life; Humans; Intraoperative Care; Male; Middle Aged; Myasthenia Gravis; Neuromuscular Blockade; Neuromuscular Nondepolarizing Agents; Postoperative Care; Rocuronium; Thymectomy; Thymus Neoplasms