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SummaryWe investigated the effect of rocuronium-and sugammadex-induced mast cell increase and degranulation in rat portal triads. Forty-two rats, in six groups, received either rocuronium 1 mg.kg ; rocuronium 1 mg.kg )1 and 5 min later, sugammadex 15 mg.kg; rocuronium 1 mg.kg )1 and 5 min later, sugammadex 100 mg.kg; or isotonic saline. Total mast cell numbers were significantly higher with rocuronium only, than in all other groups (p < 0.003), although in all active groups, the number was greater than the control. Total mast cell number was significantly higher with rocuronium and low-dose sugammadex compared with low-dose sugammadex only. The number of tryptase-positive mast cells with rocuronium only was significantly higher than in all other groups (p < 0.003). Tryptase-positive mast cell numbers in both groups receiving both rocuronium and sugammadex were significantly higher compared with both groups receiving sugammadex only. Rocuronium increased mast cell numbers, and degranulation was mitigated by sugammadex. These results suggest that sugammadex may be beneficial in treatment of rocuronium-induced anaphylaxis.

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GirişP eribulber blok, oftalmik cerrahide anestezi ve akinezi sağlamak için kullanılan rejyonal anestezi tekniklerinden biridir. Kas konusu dışına (ekstrakonal) verilen lokal anestezik ile optik sinir hasarından kaçınılmaktadır. Bundan dolayı daha fazla anestezik ajan gerektirir. Peribulber blok, birden fazla enjeksiyona gereksinim duyulması ve fazla miktarda lokal anestezik ajan verilmesi gibi dezavantajları olmasına rağmen oftalmik cerrahi öncesinde komplikasyonların azlığı nedeniyle sıklıkla tercih edilir (1). Oftalmik cerrahi geçirecek hastalarda peribulber anestezi altında major komplikasyonların oranı %0,006 olarak bildirilmiştir (2). Teorik olarak peribulber bloğun daha güvenli ve kolay olduğu düşünülmesine rağmen literatürde peribulber blok sonrası beyinsapı anestezisi gelişen vakalar bildirilmiştir (3, 4). Olgumuzda katarakt ameliyatı öncesi yapılan peribulber bloğa bağlı muhtemel beyin sapı anestezisi nedeniyle gelişen solunum depresyonu sunulmaktadır. Olgu SunumuSağ göz için elektif katarakt cerrahisi planlanan 68 yaşındaki bayan hastanın bu raporun yayınlanması için bilgilendirilmiş yazılı onamı alındı. Yaklaşık onbeş yıldır esansiyel hipertansiyonu mevcuttu ve tedavide indapamid ve triamteren kullanmaktaydı. Hipertansiyon dışında herhangi bir sistemik hastalığı olmayan hastanın laboratuar değerlerinde özellik yoktu. Preoperatif risk skoru Amerikan Anesteziyologlar Derneği (ASA: American Society of Anesthesiologists) ASA II'idi. Bir yıl önce diğer gözden peribulber blok ile katarakt cerrahisi geçiren hasta sorunsuz taburcu edilmişti. Hasta monitorize edildi (kalp hızı, elektrokardiyografi, noninvaziv kan basıncı ve oksijen satürasyonu) ve damar yolu açıldı. Katarakt cerrahisi öncesi anestezi sağlamak amacıyla 6 mL %2 lidokain hidroklorid (Jetokain ampul; Adeka İlaç San., Samsun, Türkiye) kullanılarak alt kapakta inferotemporal alt orbital kenardan lateral kantus ve lateral limbusun ortasından 25 gauge ve 25 mm uzunluğun-da iğne ile Göz Hastalıkları uzmanı tarafından peribulber blok yapıldı.Peribulbar block is used to obtain anaesthesia and akinesia of the eye by injecting a local anaesthetic around the musclecone. A patient scheduled for cataract surgery received peribulbar block with 6 mL of 2% lidocaine hydrochloride. Following the injection, confusion, hypotension and dilatation of the contralateral pupil rapidly progressed to loss of consciousness and respiratory arrest. The patient was intubated and mechanically ventilated for 30 min. The patient regained her consciousness, was extubated and transferred to the intensive care unit for further follow-up. Although brainstem anaesthesia because of peribulbar block is very rare, this procedure should be performed with complete monitorisation and resuscitation equipment. Keywords: Peribulbar anaesthesia, brainstem anaesthesia, respiratory arrest, patient monitarisation Peribulber blok ile kas konusu dışına lokal anestezik madde verilerek gözde anestezi ve akinezi sağlanmaktadır. Katarakt cerrahisi planlanan bir hastada peribulber alana 6 mL %2 lidokai...

Mast cells play a vital role in hypersensitivity reactions. Rocuronium is known to cause mast cell mobilization, hypersensitivity, and pancreatitis. The aim of this study was to investigate the effects of sugammadex on pancreatic changes due to rocuronium. A total of 42 Sprague-Dawley male rats were divided into six equal groups to receive either rocuronium 1 mg/kg intravenously (i.v., R group), rocuronium 1 mg/kg + sugammadex 16 mg/kg i.v. (RS16 group), rocuronium 1 mg/kg + sugammadex 96 mg/kg i.v. (RS96 group), sugammadex 16 mg/kg (S16), sugammadex 96 mg/kg i.v. (S96 group), or 0.9% sodium chloride (control group). Sugammadex was administered 5s later following rocuronium. In R group, mast count was higher, and the distribution rate of granules and nuclear changes were different compared with other groups. Distribution rate of granules in groups S16 and S96 were similar to the control group and lower compared with other groups. The amount of mast cells and granule density in groups RS16 and RS96 was lower compared with R group. The amount of mast cells in groups RS16 and RS96 was significantly lower compared with other treatment groups. These results suggest that sugammadex may have an inhibitory effect on mobilization and morphological changes in pancreatic mast cells induced by administration of rocuronium and sugammadex in rats.