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paralysis will result. 3 The dose of sugammadex required to reverse neuromuscular blockade is dependent on the depth of blockade. If spontaneous recovery from neuromuscular blockade has reached 2 twitches on a train of 4 (TOF), then a dose of 2 mg/kg is recommended. If there are zero twitches on a TOF, but there are 1–2 posttetanic twitches, then a dose of 4 mg/kg is recommended. If immediate reversal of complete neuromuscular blockade is needed, such as following anesthetic induction with inability to ventilate or intubate, then a dose of 16 mg/kg is recommended

. CASE PRESENTATION A 43-year-old man (height 171 cm; weight 54 kg; body mass index 18.5 kg/m 2 ) with SCA1 fell while attempting to walk independently and fractured his mandible, leading to the need for open reduction and internal fixation under general anesthesia. His clinical signs and symptoms included gait disturbance, dysarthria, dysphagia, oculomotor dysfunction, and anxiety disorder, although vocal cord paralysis was not observed on preoperative flexible fiber-optic laryngoscopy performed by an otorhinolaryngologist. Because anesthesia-induced vocal

and anaphylactic reactions mostly affect the cardiovascular and the central nervous system. 1 Localized complications include, among others, hematoma formation with the risk of trismus or infection, needle breakage, persistent postinjection paresthesia, soft tissue necrosis, spread of infection, self-inflicted soft tissue trauma, and ocular complications. 1 A rarely reported in the literature, yet alarming, localized neurologic complication after inferior dental nerve block anesthesia is facial nerve palsy. The paralysis could be either immediate or delayed

unavailable to interact at the neuromuscular junction. In dental office-based general anesthesia, paralysis is frequently not used for intubation, particularly when propofol-remifentanil mixtures and/or deep sevoflurane anesthesia are generally very reliable in obtaining good intubating conditions. However, for deep sedation and general anesthesia providers, succinylcholine has been a required neuromuscular blocking agent for the treatment of laryngospasm and for emergency intubation. Onset of paralysis with a full 1–1.5 mg/kg intubating dose, as might be used for emergency

nurses or independent anesthesia providers) are acceptable personnel to perform recovery duties, that is, interpret monitoring data; perform patient evaluation/diagnosis; perform definitive care and implementation of verbal/written orders, including the administration of vasoactive substances used for blood pressure and heart rate extremes; treatment of laryngospasm, such as the administration of succinylcholine which will cause temporary paralysis necessitating ventilation support and possible intubation; and a whole host of other resuscitation drugs and procedures

; however, the onset time for paralysis (ie, loss of spontaneous ventilation and body movement) was clearly longer than the expected onset time of intravenously administered rocuronium. Therefore, we felt it likely the subcutaneous swelling contained a significant amount of the initial rocuronium bolus. Prolongation of Paralysis Due to Infiltration In contrast to the onset time, the duration of action of infiltrated rocuronium varies between reports. 1 – 4 The following are the reasons for the differences in each case: the rocuronium

-antagonists such as buprenorphine (Suboxone, Subutex) and extended-release naltrexone (Vivtrol). NEUROMUSCULAR BLOCKADE REVERSAL DRUGS Reversal drugs that are routinely used during general anesthesia for dentistry counteract nondepolarizing neuromuscular blockade often used in intubation, emergent laryngospasm management, and surgical procedures requiring paralysis and muscular flaccidity. For this purpose, neostigmine is still commonly used, and sugammadex is now available internationally. Neostigmine

occurring in a child after induction that requires immediate paralysis to reestablish airway patency after failing the usual steps (repositioning, airway suctioning, and deepening the patient). An inattentive or poorly prepared provider may not properly recognize the issue and appropriately rescue the patient before permanent damage occurs. Someone who has never given an effective dose of succinylcholine emergently or has not done so after many years in practice may be equally hesitant. Although there are many factors at play for a successful outcome in such a scenario, 2

tube placement, and the most common contributing factors were errors in performance and/or technical knowledge. The most common specialties involved were orthopedic surgery (30%), ear, nose, and throat surgery (25%), and general surgery (20%). Comment: The most common allegation cited was “trauma from endotracheal tube placement” as opposed to “trauma from laryngoscope” or “trauma from balloon compression.” The most common complications were bilateral vocal cord paralysis, unilateral vocal cord paralysis, and laryngeal nerve injury. Proposed mechanisms of

differentiating arytenoid dislocation from transient laryngeal nerve paralysis. Contraction of the pharyngeal constrictor and cricopharyngeal muscles that accompanies swallowing moves the dislocated arytenoid cartilage and leads to pains, as is common with posterior dislocation. Similar symptoms were noted in this patient despite the anterior dislocation. In this case the arytenoid cartilage dislocation was treated conservatively with speech therapy (eg, breath-holding, vocalization, and swallowing), which promotes movement of the thyroarytenoid muscles. In cases of