Spinal muscular atrophy (SMA) is a rare lower motor neurone disease in which anesthetic management is often difficult as a result of muscle weakness, hypersensitivity to non-depolarizing neuromuscular blocking agent, and succinylcholine induced hyperkalemia. We describe a 50-year-old patient with type IV SMA for synovectomy. We decided to use an epidural technique to avoid muscle relaxants and ...

My objective is to analyze the efficiency of remifentanil-propofol and alfentanil-propofol combinations for laryngoscopic endotracheal intubation in the absence of muscle relaxants. This analysis reviews the work by Imani et al. (1). Muscle relaxants are frequently used to facilitate endotracheal intubation during anesthesia induction. However, the administration of short-acting depolarizing mu...

Neuromuscular disorders (NMDs) are a heterogeneous group of neurological and muscular diseases. Patients present with typical features such as wasting and weakness of skeletal muscles. However, despite these common clinical signs, underlying etiologies are nearly as multifaceted as the number of the diseases. For the anesthesiologist, it is very important to know the origin of a particular dise...

Malignant Hyperthermia (“MH”)—the rapid onset of extremely high fever with muscle rigidity—is caused by a runaway heat production futile cycle mediated via the sodium channels at the myoneural receptor sites. MH is not triggered by non-depolarizing muscle relaxants; however, depolarizing muscle relaxants may trigger it [1]. Here we present a de novo hypothesis of how MH is triggered and develop...

OBJECTIVE To design and fabricate a device to simulate evoked thumb adduction in response to ulnar nerve stimulation. METHODS We implemented a computer-controlled, motorized thumb (TWITCHER) that responds to ulnar nerve stimulation by an unmodified peripheral nerve stimulator. Clinically realistic response patterns are generated for both depolarizing and non-depolarizing muscle relaxants and ...

the potential changes in neuromuscular blockade after chronic (>24 h) administration of sub-paralytic doses of two newly introduced aminosteroidal muscle relaxants were investigated. org-9426 (rocuronium) and org-9487 were studied in the in vivo guinea pig gastrocnemius muscle-sciatic nerve preparation. the problems seen after prolonged administration of muscle relaxants are thought to arise fr...

Malignant hyperthermia (MH) is a pharmacogenetic disease which predisposes to the trigger of a life-threatening, hypermetabolic syndrome by potent inhaled anesthetics and by depolarizing skeletal muscle relaxants. Heat production in the anesthetized MH can be profound with 5-fold increases in oxygen consumption. The trigger anesthetics cause an abnormal, sustained rise in myoplasmic calcium lev...