Murphy G S
Department of Anesthesiology, Evanston Northwestern Healthcare, Northwestern University, Feinberg School of Medicine, IL, USA.
Minerva Anestesiol. 2006 Mar;72(3):97-109.
The residual effects of neuromuscular blocking agents may persist into the early postoperative recovery period, even when neuromuscular blockade is carefully monitored and reversed in the operating room. Recent data suggest that mild degrees of residual paresis (train-of-four TOF ratios of 0.7-0.9) may be associated with significant impairment of respiratory and pharyngeal muscle function. Therefore, the new gold standard reflecting acceptable neuromuscular recovery is a TOF ratio > or =0.9. Several investigations have demonstrated that many patients continue to arrive in the postanesthesia care unit with TOF ratios <0.7-0.9. Several techniques may be used to reduce the risk of postoperative residual paresis, which include avoidance of long-acting muscle relaxants, use of neuromuscular monitoring in the operating room, routine reversal of neuromuscular blockade at a TOF count of 2-3, and early administration of reversal agents. Careful management of neuromuscular blockade may limit the occurrence of adverse events associated with residual postoperative paralysis. Large-scale outcome studies are needed to clearly define the impact of residual neuromuscular block on major morbidity and mortality in surgical patients.
神经肌肉阻滞剂的残余效应可能会持续到术后早期恢复阶段，即便在手术室中对神经肌肉阻滞进行了仔细监测并予以逆转。近期数据表明，轻度残余麻痹（四个成串刺激（TOF）比值为0.7 - 0.9）可能与呼吸及咽部肌肉功能的显著受损有关。因此，反映可接受的神经肌肉恢复情况的新金标准是TOF比值≥0.9。多项研究表明，许多患者进入麻醉后护理单元时TOF比值仍＜0.7 - 0.9。可采用多种技术来降低术后残余麻痹的风险，包括避免使用长效肌肉松弛剂、在手术室中使用神经肌肉监测、当TOF计数为2 - 3时常规逆转神经肌肉阻滞以及早期给予逆转剂。对神经肌肉阻滞进行仔细管理可能会限制与术后残余麻痹相关的不良事件的发生。需要开展大规模的结局研究来明确界定残余神经肌肉阻滞对外科手术患者主要发病率和死亡率的影响。
