Evaluation of Transcutaneous Electroacupoint Stimulation with the Train-of-four Mode for Preventing Nausea and Vomiting after Laparoscopic Cholecystectomy

Objective： To evaluate the efficacy of transcutaneous electroacupoint stimulation with a train-of-four （TOF） mode for the prevention of postoperative nausea and vomiting （PONV） in the patients undergoing laparoscopic cholecystectomy. Methods： Ninety-six ASA Grade Ⅰ-Ⅱ patients scheduled for laparoscopic cholecystectomy were randomized into Neiguan （P6） electroacupoint stimulation group （treated group） and a placebo control group （placement of electrodes without electroacupoint stimulation）. The anesthetic regimen was standardized by needling at Neiguan on the left side and connecting the TOF peripheral nerve stimulator. The incidence of nausea, vomiting, severity, antiemetic dosage and the degree of pain were assessed at 0, 60, 120 min, and 24 h after surgery. Results： The incidence of nausea and vomiting, the dose of antiemetics and the occurrence of severe nausea were all significantly lower in the treated group compared with the control group and the score for pain was obviously reduced in patients of the treated group at 24 h post-operation （P〈0.05 or P〈0.01）. Conclusion： Transcutaneous electroacupoint stimulation at P6 with the TOF mode could reduce the incidence and severity of nausea and vomiting with analgesic effects.

Unexpected delayed reversal of rocuronium-induced neuromuscular blockade by sugammadex:A case report and review of literature

BACKGROUND Rocuronium,a nondepolarizing muscle relaxant,is usually administered during general anesthesia to facilitate endotracheal intubation and keep patients immobile during the surgery.Sugammadex,the selective reversal agent of rocuronium,fully reverses the neuromuscular blockade(NMB)at the end of surgery.Most reports show that sugammadex rapidly achieves a ratio of train-offour(TOF),a quantitative method of neuromuscular monitoring,of 0.9 which ensures adequate recovery for safe extubation.However,very rare patients with neuromuscular diseases may respond poorly to sugammadex.CASE SUMMARY A 69-year-old female presented with abdominal fullness and nausea,and was diagnosed with gastroparesis.She underwent gastric peroral endoscopic myotomy under general anesthesia with rocuronium(0.7 mg/kg).At the end of surgery,sugammadex 3.6 mg/kg was administered when TOF showed 2 counts.Afterward,the TOF ratio recovered to 0.65 in 30 min.She was awake but could not fully open her eyelids.The tidal volume during spontaneous breathing was low.After additional doses of sugammadex(up to 7.3 mg/kg)in the following 3 h,the TOF ratio was 0.9,and the endotracheal tube was smoothly removed.After excluding possible mechanisms underlying the prolonged recovery course,we speculated our patient may have had an undiagnosed neuromuscular disease,hinted by her involuntary movement of the tongue and mouth.Furthermore,her poor renal function and history of delayed recovery from general anesthesia may be related to the long duration of rocuronium.CONCLUSION In our case,both prolonged rocuronium-induced NMB and poor response to sugammadex were noted.To optimize the dose of rocuronium,perioperative TOF combined with other neuromuscular monitoring is suggested.

The Safe Use of Sugammadex “Rescue” after Neostigmine: 2 Case Reports

With the introduction of the rocuronium and vecuronium binding agent sugammadex into clinical practice in the United States, its use for reversal of neuromuscular blockade will likely start in some institutions as a “rescue” after failed reversal with neostigmine. However, sugammadex after neostigmine has not been extensively studied. Therefore, there is a question as to its effectiveness when used in this way especially in the airway compromised patients that the anesthesia provider will commonly face in this situation. Furthermore, there is a possibility of hemodynamic compromise. These two case reports demonstrate the safe and effective use of sugammadex after failed reversal with neostigmine.