Robot-assisted radical prostatectomy is a relatively re-cent technique. Its advantages include less invasiveness and better pain management, but has specific anesthesia requirements, such as steep Trendelenburg position and pneumoperitoneum. Mild complications are common, e.g., transient hypotension or soft tissue edema.We present a case of a 62-year old male who developed subgaleal hematoma associated with transient neurologic impairment after surgery. Jugular vein insufficiency was suspected as the most likely cause. The patient recovered fully.Robot-assisted radical prostatectomy can be a challeng-ing procedure due to the anesthesia requirements, but most complications are mild and transient. However, patients should be carefully assessed before surgery. We identified potential factors that may have led to this complication: the abnormal prolonged surgical time, the steep Trende-lenburg, a non-assessed jugular vein insufficiency, and/or patient's obesity.

Background: Sugammadex has been associated with increases in the bispectral index (BIS). We evaluated the effects of sugammadex administration on quantitative electroencephalographic (EEG) and electromyographic (EMG) measures.Methods: We performed a prospective observational study of adult male patients undergoing robot-assisted radical prostatectomy. All patients received a sevoflurane-based general anaesthetic and a continuous infusion of rocuronium, which was reversed with 2 mg kg(-1) of sugammadex i.v. BIS, EEG, and EMG measures were captured with the BIS VistaTM monitor.Results: Twenty-five patients were included in this study. Compared with baseline, BIS increased at 4-6 min (13 coefficient: 3.63; 95% confidence interval [CI]: 2.22-5.04; P<0.001), spectral edge frequency 95 (SEF95) increased at 2-4 min (13 coefficient: 0.29; 95% CI: 0.05-0.52; P=0.016) and 4-6 min (13 coefficient: 0.71; 95% CI: 0.47-0.94; P<0.001), and EMG increased at 4-6 min (13 coefficient: 1.91; 95% CI: 1.00-2.81; P<0.001) after sugammadex administration. Compared with baseline, increased beta power was observed at 2-4 min (13 coefficient: 93; 95% CI: 1-185; P=0.046) and 4-6 min (13 co-efficient: 208; 95% CI: 116-300; P<0.001), and decreased delta power was observed at 4-6 min (13 coefficient: -526.72; 95% CI: -778 to -276; P<0.001) after sugammadex administration. Neither SEF95 nor frequency band data analysis adjusted for EMG showed substantial differences. None of the patients showed clinical signs of awakening.Conclusions: After neuromuscular block reversal with 2 mg kg(-1) sugammadex, BIS, SEF95, EMG, and beta power showed small but statistically significant increases over time, while delta power decreased.

Inhaled anaesthetic induction with sevoflurane is very common in the pediatric population. Sevoflurane systemic effects are widely known, while not all the side effects are known. We present a four year-old child who developed a persistent supraventricular tachycardia after inhaled anaesthetic induction with sevoflurane. The arrhythmia did not end until sevoflurane was stopped and changed to an intravenous continuous perfusion of hypnotic drugs (propofol and remiphentanyl). The exact mechanism for such a causal relationship with sevoflurane administration is unknown, and possible diagnoses include atrioventricular nodal reentry tachycardia (AVNRT) and the existence of an accessory pathway. An episode of persistent supraventricular tachycardia with a clear causal relationship with sevoflurane administration is not found in the literature.