Reversible lactic acidosis and electrocardiographic changes in a neurosurgical patient during propofol anesthesia.

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Sugammadex in anesthesia practice

Sugammadex in anesthesia practiceNovember 2010, Vol. 11, No. 16 , Pages 2759-2771 (doi:10.1517/14656566.2010.528391) Philippe Duvaldestin ? & Benoit Plaud Service d'Anesth?sie, R?animation Chirurgicale, SAMU 94–SMUR, Groupe Hospitalier et Universitaire Albert-Chenevier–Henri-Mondor, 51, avenue du Mar?chal-de-Lattre-de-Tassigny, 94010 Cr?teil Cedex, France +33 0149 812 111 # 35901; +33 0149 814 348; philippe.duvaldestin@hmn.aphp.fr

Importance of the field: Neuromuscular blocking agents are currently used during anesthesia but put patients at risk of postoperative paralysis. If the residual neuromuscular blockade is not reversed properly at the end of anesthesia, there is a risk of hypoxemia and pulmonary complication. Sugammadex is able to fully reverse different degrees of neuromuscular blockade induced by steroidal neuromuscular blocking agents.

Areas covered in this review: This review provides a background to the use of neuromuscular blocking agents during anesthesia. It also describes the mechanism of reversal and the clinical efficacy of sugammadex, and discusses the future changes in clinical anesthesia induced by this new selective binding agent.

What the reader will gain: An understanding of the rationale and use of sugammadex as a reversal agent of different degrees of neuromuscular blockade and the use of the high-dose rocuronium–sugammadex combination as an alternative to succinylcholine for rapid sequence induction.

Take home message: Sugammadex provides an original mechanism of reversing the effect of neuromuscular steroidal agent by direct inactivation in plasma. Although its effect is spectacular, it is questionable whether this drug will change current practice.

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Spinal anesthesia in a child with Brachmann-de Lange (Cornelia de Lange) syndrome

Providing anesthesia to patients with Brachmann-de Lange syndrome (BdLS) may be challenging, mainly because of intubation difficulty, gastroesophageal reflux disease, and aspiration complications. The use of spinal anesthesia (SA) in this population has not been reported. We report the uneventful administration of awake SA to a 7-month-old girl with BdLS who was scheduled for rectal biopsy. The current literature is reviewed to discuss the indications for SA in those patients. Keywords  Spinal anesthesia - Brachmann-de Lange syndrome - Children

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