No abstract

Severe pulmonary thromboembolism (PE) during pregnancy occurred in 2 young patients. One patient died from PE recurrence without placement of an inferior vena cava (IVC) filter, but the other survived with emergent filter placement before cesarean section. A 31-year-old woman presented with sudden dyspnea at 34 weeks of pregnancy. On examination, she was cyanotic and echocardiography revealed marked right heart dilatation and pulmonary hypertension. An emergent cesarean section was performed, but soon after the delivery, she fell into circulatory arrest. PE recurrence was suggested as cause, and t-PA was administered into the pulmonary artery. She was resuscitated but she died from another PE recurrence 4 days later. A 25-year-old woman, 35 weeks pregnant was admitted because of threatened abortion. She felt sudden dyspnea 3 days after admission and was diagnosed with severe PE by echocardiography and pulmonary catheterization. A Vena-Tech IVC filterTM was inserted at the suprarenal position to prevent PE relapse. Emergent cesarean section was then carried out uneventfully. Heparin and urokinase were administered postoperatively, and her pulmonary arterial pressure decreased. She was extubated 7 days later, and is now doing well 10 months later. Once severe PE has occurred, its relapse may be lethal. The IVC filter is effective in preventing recurrence. Even if the patient is young, emergent IVC filter placement to avoid fatal PE relapse is essential. (JJAAM 1999: 10: 692-6)

Abstract:We investigated the differences between males and females in the reversal effect of neostigmine on neuromuscular blockade. Thirty male and 30 female patients undergoing elective general anesthesia were studied. Vecuronium was given in all patients anesthetized with nitrous oxide, oxygen, and sevoflurane. After the surgical procedure, when T1 (lst response in train-of-four (TOF»/control returned to 0.25, neostigmine 40 ,ug/kg in combination with atropine 20 ,ug/kg was given to antagonize residual neuromuscular blockade. Three, six, nine, 12, and 15 minutes after neostigmine reversal, T1/control or TOF ratio (T4/T1) did not significantly differ between the sexes. Also, 15 minutes after neostigmine administration, the number of patients in whom recovery from neuromuscular blockade was sufficient to guarantee good respiratory function, i.e., TOF ratio> 0.74, did not significantly differ between the sexes. In contrast, 15 minutes after neostigmine, the number of patients in whom recovery from neuromuscular blockade was adequate to ensure satisfactory recovery from neuromuscular blockade including the return of the faculty of sight, i.e., TOF ratio>0.9, was significantly less in the males than in females (6 vs 14, P = 0.028). In conclusion, 15 min after neostigmine, TOF ratio less often returns to a value of more than 0.9 in males than in females.