Department of Anaesthesiology and Intensive Care Medicine, University of Rostock, Rostock, Germany.
Eur J Anaesthesiol. 2011 Dec;28(12):842-8. doi: 10.1097/EJA.0b013e328345cd11.
Residual paralysis is associated with post-operative pulmonary complications, including critical respiratory events.
We determined the incidence of critical respiratory events, such as hypoxaemia, in patients with minimal residual neuromuscular blockade and compared these data with those from patients with full recovery of blockade.
Randomised, prospective, placebo-controlled trial.
Single centre; Rostock, Germany, from January 2007 to February 2008.
One hundred and thirty-two adult patients, aged 18-80 years, with the American Society of Anesthesiology I-III physical status, undergoing orthopaedic surgery under general anaesthesia, including rocuronium to produce neuromuscular blockade; 114 patients were randomised to one of two groups: neostigmine group (neostigmine 20 μg kg-1) or placebo group (saline).
In the patients in the neostigmine group, the tracheal tube was removed at a train-of-four (TOF) ratio of 1.0; in the patients in the placebo group, the trachea was extubated at a TOF ratio less than 1.0, but without fade in TOF and double-burst stimulation (DBS). Neuromuscular monitoring was assessed simultaneously with qualitative TOF/DBS monitoring, and with quantitative calibrated acceleromyography. Critical respiratory events, such as hypoxaemia, were assessed in the post-anaesthesia care unit.
Forty-five patients (39.5%) became hypoxaemic (SaO2 < 93%); there was a significant difference between the groups (29 patients in the placebo group versus 16 in the neostigmine group; P = 0.021).
In the neostigmine group, all patients were extubated at a TOF ratio of 1.0. In the placebo group, the median TOF ratio was 0.7 (range: 0.46-0.9; P < 0.001). The median time for spontaneous recovery in the placebo group was 16 min (range 3-49 min). Neostigmine 20 μg kg was effective in antagonising rocuronium-induced blockade without fade in TOF and DBS.
In this randomised, prospective, placebo-controlled trial, minimal residual block was associated with hypoxaemia in the post-anaesthesia care unit. Neostigmine 20 μg kg was effective in antagonising rocuronium-induced (minimal) blockade.
残余性瘫痪与术后肺部并发症有关，包括严重的呼吸事件。
我们确定了在有轻微残余神经肌肉阻滞的患者中出现严重呼吸事件（如低氧血症）的发生率，并将这些数据与阻滞完全恢复的患者的数据进行了比较。
随机、前瞻性、安慰剂对照试验。
单中心；德国罗斯托克，2007 年 1 月至 2008 年 2 月。
132 名成年患者，年龄 18-80 岁，美国麻醉医师协会体格状况 I-III 级，全身麻醉下接受骨科手术，包括罗库溴铵产生神经肌肉阻滞；114 名患者随机分为两组：新斯的明组（新斯的明 20μg/kg）或安慰剂组（生理盐水）。
新斯的明组患者在四成比（TOF）为 1.0 时拔管；安慰剂组患者在 TOF 比小于 1.0 时拔管，但没有 TOF 衰减和双爆发刺激（DBS）。神经肌肉监测与定性 TOF/DBS 监测同时进行，并与定量校准加速度肌电图同时进行。在麻醉后护理单位评估严重的呼吸事件，如低氧血症。
45 名患者（39.5%）出现低氧血症（SaO2＜93%）；两组之间有显著差异（安慰剂组 29 例，新斯的明组 16 例；P=0.021）。
新斯的明组所有患者均在 TOF 比为 1.0 时拔管。在安慰剂组，TOF 比中位数为 0.7（范围：0.46-0.9；P＜0.001）。安慰剂组患者自发恢复的中位数时间为 16 分钟（范围 3-49 分钟）。新斯的明 20μg/kg 对抗罗库溴铵诱导的阻滞有效，且无 TOF 和 DBS 衰减。
在这项随机、前瞻性、安慰剂对照试验中，轻微的残留阻滞与麻醉后护理单位的低氧血症有关。新斯的明 20μg/kg 对抗罗库溴铵诱导的（轻微）阻滞有效。
