In Cheol Choi

Pretreatment of rocuronium reduces the frequency and severity of etomidate-induced myoclonus

STUDY OBJECTIVEnTo investigate the effect of pretreatment with a low dose of rocuronium on the occurrence of etomidate-induced myoclonus.nnnDESIGNnProspective, randomized, double-blinded study.nnnSETTINGnMedical center in South Korea.nnnPATIENTSn110 ASA physical status I, II, and III patients scheduled for elective cardiac or pulmonary surgery with general anesthesia.nnnINTERVENTIONSnAll patients were randomized to pretreatment with a low dose of rocuronium (0.06 mg/kg; Group R) or placebo (saline; Group S), followed three minutes later by etomidate (0.3 mg/kg).nnnMEASUREMENTSnPatients were monitored for myoclonic movements and pain on a scale of 0-3. Bispectral index (BIS) and electromyographic (EMG) activity were recorded continuously throughout the procedure.nnnMAIN RESULTSnFrequency of myoclonus was significantly lower in Group R (25%) than in Group S (63%). In the latter group, there was no difference in the frequency of male (59%) and female (68%) patients experiencing myoclonus. In Group S, EMG activity and BIS were significantly increased in patients who experienced severe myoclonus, and BIS was well correlated with EMG activity.nnnCONCLUSIONSnPretreatment with a small dose of rocuronium before induction of anesthesia with etomidate significantly reduced the frequency of myoclonus.

Comparison of Uncalibrated Arterial Pressure Waveform Analysis with Continuous Thermodilution Cardiac Output Measurements in Patients Undergoing Elective Off-Pump Coronary Artery Bypass Surgery

OBJECTIVEnMonitoring of cardiac output is required during anesthesia for off-pump coronary artery bypass (OPCAB) surgery. Recently, FloTrac, a new device for arterial pressure waveform analysis for cardiac output (APCO) monitoring without external calibration, was developed. The authors have compared APCO with STAT-mode continuous cardiac output (SCCO) in patients undergoing OPCAB surgery.nnnDESIGNnA clinical study.nnnSETTINGnA university hospital (single institution).nnnPARTICIPANTSnThirty consecutive patients undergoing elective OPCAB surgery.nnnINTERVENTIONSnArterial pressure measurement with FloTrac, pulmonary arterial catheter insertion.nnnMEASUREMENTS AND MAIN RESULTSnAPCO and SCCO measurements were recorded after pulmonary artery catheter insertion (T1), after sternotomy (T2), after heart positioning for left anterior descending artery anastomosis (T3, T4), after heart positioning for obtuse marginal artery anastomosis (T5, T6), after heart positioning for posterior descending artery anastomosis (T7, T8), and after sternal closure (T9). APCO and SCCO were compared using the Bland-Altman method and the percentage error by Critchleys criteria. SCCO and APCO ranged from 2.1 to 6.9 L/min and 1.2 to 7.4 L/min, respectively, and showed low correlation (r = 0.29). The overall bias by the Bland-Altman method between SCCO and APCO was -0.23 L/min, with a precision of -1.4 to 0.9 L/min, and the overall limits of agreement were -2.5 to 2.0 L/min. The overall mean CO was 4.0 ± 0.95 L/min. The overall percentage error between SCCO and APCO measurements was 57%.nnnCONCLUSIONSnUncalibrated APCO values do not agree with thermodilution SCCO and significantly overestimated the SCCO in patients undergoing OPCAB surgery. Further evaluation is required to verify the clinical acceptance of FloTrac APCO in OPCAB surgery.