Cisatracurium is a widely used non-depolarizing neuromuscular blocking agent during anesthesia; however, residual neuromuscular blockade post-surgery can lead to severe respiratory complications, highlighting the urgent need for effective reversal agents. In this study, we designed and synthesized a highly water-soluble acylhydrazone macrocycle featuring an electron-rich cavity as an efficient supramolecular reversal agent for cisatracurium. The macrocycle binds cisatracurium through electrostatic and hydrophobic interactions, exhibiting a binding constant of up to 105 M-1. Cytotoxicity assays confirmed its excellent biocompatibility, and in vivo studies in cisatracurium-anesthetized mice demonstrated that the macrocycle effectively reverses cisatracurium-induced neuromuscular blockade. This work provides a new strategy for developing water-soluble acylhydrazone macrocycles as potential supramolecular reversal agents for neuromuscular blockers.

Neonates comprise a special population of patients undergoing surgery, and the presence of congenital defects further complicates their anaesthetic management. This report describes a neonate born with Arnold-Chiari malformation and a ruptured myelomeningocele, who was later found to also have a double-outlet right ventricle. This report outlines the careful selection of anaesthetic agents and perioperative strategies tailored to the patient's compounded neurologic and cardiac congenital defects while catering to the surgical requirements. The patient underwent repair of the MMC under total intravenous anaesthesia induced with midazolam, ketamine and atracurium and maintained with a combination of dexmedetomidine and fentanyl. The combination of dexmedetomidine and fentanyl appears to be a viable option for neonates with rigid perioperative haemodynamic goals and a need for neuroprotection. We report the safe use of dexmedetomidine for total intravenous anaesthesia pending more robust evidence in this patient population.

Postsurgical parotitis is a rare postoperative complication characterised by acute, transient unilateral or bilateral swelling of the salivary glands of unclear origin. This case report aims to analyse the management and causes of postsurgical parotitis.A female patient in her mid-40s was admitted for an elective laparotomy and myomectomy due to a symptomatic uterine myoma measuring 3×4 cm, associated with recurrent metrorrhagia. Her medical history included bulimia nervosa and being moderately underweight. Anaesthetic drugs administered during the induction included fentanyl, propofol and atracurium, and for maintenance included sevoflurane and fentanyl. Intravenous atropine was administered intraoperatively in response to severe bradycardia triggered by uterine stimulation. Following extubation, the patient developed bilateral swelling of the parotid glands. The patient remained stable and did not require respiratory support. Symptomatic management was provided, and the swelling had resolved by the time of the follow-up visit, within 1 week after surgery.

With the growing number of elderly patients undergoing surgical procedures, the use of neuromuscular blocking agents (NMBAs) in geriatric anesthesia has become increasingly relevant. Aging is associated with physiological and pathological changes that affect drug pharmacokinetics and pharmacodynamics, including reduced renal and hepatic function, altered body composition, and decreased plasma protein levels. These changes influence the onset, duration, and recovery from neuromuscular blockade, increasing the risk of postoperative residual curarization (PORC) and respiratory complications. This narrative review summarizes current knowledge on the use of depolarizing and non-depolarizing NMBAs in elderly patients, including benzylisoquinolines (atracurium, cisatracurium, mivacurium) and aminosteroids (rocuronium, vecuronium, pancuronium, pipecuronium). Age-related differences in drug metabolism, distribution, and elimination are discussed, along with the clinical implications for dosing, recovery, and safety. The role of reversal agents, including neostigmine and sugammadex, is emphasized, highlighting their efficacy and safety profiles in older adults. Special attention is given to neuromuscular monitoring, particularly objective quantitative methods as a critical tool to prevent residual blockade. Individualized management strategies, careful agent selection, and vigilant monitoring are essential to optimize safety and outcomes in elderly patients. Despite age-related pharmacological changes, appropriate use of short-acting or organ-independent NMBAs, combined with reversal agents and neuromuscular monitoring, allows for effective and safe anesthesia in the geriatric population. Future research should focus on large-scale studies to better define age-specific NMBA dosing and monitoring guidelines.

We presented the case of a patient who experienced a loss of responsiveness shortly after the tourniquet was deflated following knee arthroscopy. Incorrect intra-articular drug administration was suspected, and upon investigation, a used ampule of atracurium, instead of tranexamic acid, was found in the safety box. The patient was promptly treated with neostigmine and received supportive respiratory care, resulting in the reversal of symptoms, full recovery, and discharge after two days. Adhering to the six rules of drug administration is essential to prevent patient harm due to incorrect drug administration. We recommend placing warning notes in each operating room to raise awareness of potential drug mix-ups due to their similar appearances. Furthermore, during intra-articular injections, the technician needs to verify the medication with the surgeon before administering the injection.