Adamus M, Koutná J, Neoral C
Klinika anesteziologie a resuscitace, Fakultní nemocnice a lékarská fakulta Univerzity Palackého, Olomouc.
Rozhl Chir. 2007 Jan;86(1):11-6.
In 513 patients, we investigated residual curarization after general anaesthesia with rocuronium administered, without peroperative neuromuscular blockade monitoring. On admission to the recovery room, the ulnar nerve was stimulated submaximally (30 mA) and the evoked muscle response was quantified with accelerometry (TOF-Watch SX, Organon). The postoperative residual curarization was defined as a TOF-ratio < 0.9 and could be demonstrated in 174 patients (34 %). Compared to the group with adequate recovery, these patients received larger rocuronium dose [45.4 (SD 13.2) mg vs. 40.4 (SD 14.3) mg, p < 0.01], less experienced anaesthesiologists conducted their case [p <0.01], shorter time had elapsed since the last rocuronium dose [58.4 (20.9) min. vs. 64.9 (27.2) min., p < 0.05], their core temperature was lower [35.4 (0.6) degrees C vs. 35.8 (0.6) degrees C, p < 0.011 and on average, they received less neostigmine during anaesthesia [0.26 (0.47) mg vs. 0.57 (0.71) mg, p < 0.01]. We conclude that it is necessary to antagonize residual block after rocuronium, especially in the absence of perioperative neuromuscular monitoring.
在513例患者中,我们研究了在未进行术中神经肌肉阻滞监测的情况下,使用罗库溴铵进行全身麻醉后的残余肌松情况。在进入恢复室时,以次最大强度(30 mA)刺激尺神经,并使用加速度计(TOF-Watch SX,欧加农公司)对诱发的肌肉反应进行量化。术后残余肌松定义为四个成串刺激比值(TOF-ratio)<0.9,在174例患者(34%)中得到证实。与恢复良好的组相比,这些患者接受了更大剂量的罗库溴铵[45.4(标准差13.2)mg对40.4(标准差14.3)mg,p<0.01],实施麻醉的麻醉医生经验较少[p<0.01],距最后一次给予罗库溴铵的时间较短[58.4(20.9)分钟对64.9(27.2)分钟,p<0.05],他们的核心体温较低[35.4(0.6)℃对35.8(0.6)℃,p<0.011],并且在麻醉期间平均接受的新斯的明较少[0.26(0.47)mg对0.57(0.71)mg,p<0.01]。我们得出结论,有必要拮抗罗库溴铵后的残余阻滞,尤其是在没有术中神经肌肉监测的情况下。