Anaesthetic management of Stiff Man syndrome

Stiff Man syndrome or stiff-person syndrome is a rare autoimmune disorder. It is characterized by increased axial muscular tone and limb musculature, and painful spasms triggered by stimulus. The case is presented of a 44-year-old man with stiff-person syndrome undergoing an injection of botulinum toxin in the urethral sphincter under sedation. Before induction, all the surgical team were ready in order to minimise the anaesthetic time. The patient was monitored by continuous ECG, SpO2 and non-invasive blood pressure. He was induced with fractional dose of propofol 150 mg, fentanyl 50 μg and midazolam 1mg. Despite careful titration, the patient had an O2 saturation level of 90%,which was resolved by manual ventilation. There was no muscle rigidity or spasm during the operation. Post-operative recovery was uneventful and the patient was discharged 2 days later. A review of other cases is presented. The anaesthetic concern in patients with stiff-person syndrome is the interaction between the anaesthetic agents, the preoperative medication, and the GABA system. For a safe anaesthetic management, total intravenous anaesthesia is recommended instead of inhalation anaesthetics, as well as the close monitoring of the respiratory function and the application of the electrical nerve stimulator when neuromuscular blockers are used.

Thinning effects on carbon allocation to fine roots in a Quercus ilex forest

The dynamics of the fine root system are relevant to calculations of the carbon balance of the ecosystem, and there is also a need to quantify changes in this component caused by disturbances. Mediterranean forest systems have historically been coppiced to obtain charcoal. As a result of the resprouting capacity of holm oaks (Quercus ilex L.), these forests present more than 50% of their biomass below ground (stump + roots > 1 cm in diameter), but the effects of thinning on the fine root system are unknown. Fine root biomass, production, mortality and longevity were studied in a control and a thinned Mediterranean holm oak forest by minirhizotron methodology. Observations of fine roots started 2 years after thinning and continued for almost 3 years. Extraction of 80% of the former basal area of the forest greatly affected carbon allocation patterns. Biomass increased by more than 100%, production increased by 76%, mortality increased by 32% and longevity decreased by around 2 weeks. The greatest differences between treatments were associated with differences in growth during autumn months in the top 40 cm of soil, particularly between 10 and 20 cm depth.