Murphy Glenn S, Szokol Joseph W, Marymont Jesse H, Greenberg Steven B, Avram Michael J, Vender Jeffery S
Department of Anesthesiology, Evanston Northwestern Healthcare, Evanston, Illinois 60201, USA.
Anesth Analg. 2008 Jul;107(1):130-7. doi: 10.1213/ane.0b013e31816d1268.
Incomplete recovery of neuromuscular function may impair pulmonary and upper airway function and contribute to adverse respiratory events in the postanesthesia care unit (PACU). The aim of this investigation was to assess and quantify the severity of neuromuscular blockade in patients with signs or symptoms of critical respiratory events (CREs) in the PACU.
We collected data over a 1-yr period. PACU nurses identified patients with evidence of a predefined CRE during the first 15 min of PACU admission. Train-of-four (TOF) ratios were immediately quantified in these patients using acceleromyography (cases). TOF data were also collected in a control group that consisted of patients undergoing a general anesthetic during the same period who were matched with the cases by age, sex, and surgical procedure.
A total of 7459 patients received a general anesthetic during the 1-yr period, of whom 61 developed a CRE. Forty-two of these cases were matched with controls and constituted the study group for statistical analysis. The most common CREs among matched cases were severe hypoxemia (22 of 42 patients; 52.4%) and upper airway obstruction (15 of 42 patients; 35.7%). There were no significant differences between the cases and matched controls in any measured preoperative or intraoperative variables. Mean (+/-sd) TOF ratios were 0.62 (+/-0.20) in the cases, with 73.8% of the cases having TOF ratios <0.70. In contrast, TOF values in the controls were 0.98 (+/-0.07) (a difference of -0.36 with a 95% confidence interval of -0.43 to -0.30, P < 0.0001), and no control patients were observed to have TOF values <0.70 (the 95% confidence interval of the difference was 59%-85%, P < 0.0001).
A high incidence of severe residual blockade was observed in patients with CREs, which was absent in control patients without CREs. These findings suggest that incomplete neuromuscular recovery is an important contributing factor in the development of adverse respiratory events in the PACU.
神经肌肉功能未完全恢复可能会损害肺部和上呼吸道功能，并导致麻醉后监护病房（PACU）出现不良呼吸事件。本研究的目的是评估和量化PACU中出现严重呼吸事件（CRE）体征或症状的患者的神经肌肉阻滞严重程度。
我们在1年的时间内收集数据。PACU护士在患者进入PACU的前15分钟内识别出有预定义CRE证据的患者。使用加速度肌电图立即对这些患者的四个成串刺激（TOF）比率进行量化（病例组）。在同期接受全身麻醉的对照组中也收集了TOF数据，对照组患者在年龄、性别和手术方式上与病例组相匹配。
在这1年期间，共有7459例患者接受了全身麻醉，其中61例出现了CRE。这些病例中有42例与对照组匹配，构成了用于统计分析的研究组。匹配病例中最常见的CRE是严重低氧血症（42例患者中的22例；52.4%）和上呼吸道梗阻（42例患者中的15例；35.7%）。病例组和匹配对照组在任何术前或术中测量变量上均无显著差异。病例组的平均（±标准差）TOF比率为0.62（±0.20），73.8%的病例TOF比率<0.70。相比之下，对照组的TOF值为0.98（±0.07）（差异为-0.36，95%置信区间为-0.43至-0.30，P<0.0001），未观察到对照组患者的TOF值<0.70（差异的95%置信区间为59%-85%，P<0.0001）。
在出现CRE的患者中观察到严重残余阻滞的发生率很高，而在没有CRE的对照患者中则不存在。这些发现表明，神经肌肉恢复不完全是PACU中不良呼吸事件发生的一个重要促成因素。
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