Changes in the cerebral state index (CSI) during intraoperative cardiac arrest.

trachea [2]. For this reason, fibreoptic endotracheal intubation is advisable. Ljunghall and colleagues showed that patients with HPT who were apparently asymptomatic preoperatively did not have defects of their neuromuscular transmission that were of clinical significance [5]. In asymptomatic pHPT neither consistent abnormality of neuromuscular transmission nor abnormal muscle structure was found [6]. On the contrary, Al Mohaya and colleagues reported a decreased response to both succinylcholine and atracurium in a patient with parathyroid adenoma [3]. In patients there was a decreased duration of action of cis-atracurium. There was recovery of T1 to 25% of control at 26.9 min and repeated doses of cis-atracurium (0.03 mg kg) administered to maintain relaxation during surgery provided a clinical duration 10.26 0.8 min. Wuffel and colleagues reported that recovery index 25–75% and time to a TOF ratio of 0.70 of cis-atracutium were prolonged significantly by sevoflurane compared with total intravenous anaesthesia [7]. However, in our patient, increased minimum alveolar concentration (MAC) of sevoflurane did not result in significant effects on duration of or recovery from the block. On the contrary, recovery was considerably shorter in our patient. Intraoperative electrolytes and acid–base balance status were normal and normothermia was maintained. In conclusion, special attention should be paid to neuromuscular function monitoring in patients with pHPT. A. Papadima, E. E. Lagoudianakis, H. Markogiannakis, A. Pappas, A. Manouras First Department of Propaedeutic Surgery Hippocrateion Hospital Athens Medical School Athens, Greece