de Souza Camila Machado, Romero Fernanda Elizabeth, Tardelli Maria Angela
Division of Anesthesiology, Pain and Intensive Care Medicine, UNIFESP, São Paulo, SP, Brazil.
Rev Bras Anestesiol. 2011 Mar-Apr;61(2):145-9, 150-5, 78-83. doi: 10.1016/S0034-7094(11)70019-8.
Studies show the importance of monitoring neuromuscular function in preventing the residual block. However, most anesthesiologists in their daily practice base their evaluation of the recovery of neuromuscular function on clinical data. The aim of this study was to assess the degree of neuromuscular blockade in children undergoing general anesthesia at the time of block reversal and the removal of the endotracheal tube.
We evaluated children between 3 months and 12 years of age undergoing general anesthesia with the use of atracurium or rocuronium. Monitoring was initiated at the time of reversal of neuromuscular blockade and/or removal of the endotracheal tube. The anesthesiologist was not informed about the T₄/T₁ value; he/she was only alerted when the time was inadequate for the removal of the endotracheal tube. Since the start of the monitoring process, the degree of neuromuscular blockade was registered, as well as the interval of recovery of the T(4)/T₁ ≥ 0.9 ratio, the doses of neostigmine and blocker used, the expired fraction of the inhalational agent, the duration of the anesthesia, and core and peripheral temperatures.
Neuromuscular blockade was reversed in 80% of the children of the Rocuronium Group and in 64.5% of the Atracurium Group. The reversal was incorrect in 45.8% of the Rocuronium Group and in 25% of the Atracurium Group. The incidence of T₄/T₁ < 0.9 at the time of the removal of the endotracheal tube was 10% in both groups.
When deciding to remove the endotracheal tube based on clinical criteria, 10% of children had T₄/T₁ < 0.9 regardless the blocker received. A considerable number of patients had the neuromuscular blockade incorrectly reversed when the blockade was still too deep or even already recovered.
研究表明监测神经肌肉功能对预防残余肌松的重要性。然而，大多数麻醉医生在日常实践中对神经肌肉功能恢复的评估基于临床数据。本研究的目的是评估接受全身麻醉的儿童在肌松逆转和气管插管拔除时神经肌肉阻滞的程度。
我们评估了3个月至12岁使用阿曲库铵或罗库溴铵进行全身麻醉的儿童。在神经肌肉阻滞逆转和/或气管插管拔除时开始监测。麻醉医生未被告知T₄/T₁值；仅在气管插管拔除时间不足时得到提醒。自监测过程开始，记录神经肌肉阻滞程度、T(4)/T₁≥0.9比值的恢复间隔、新斯的明和阻滞剂的使用剂量、吸入麻醉剂的呼出分数、麻醉持续时间以及核心温度和外周温度。
罗库溴铵组80%的儿童和阿曲库铵组64.5%的儿童肌松被逆转。罗库溴铵组45.8%和阿曲库铵组25%的逆转不正确。两组在气管插管拔除时T₄/T₁<0.9的发生率均为10%。
基于临床标准决定拔除气管插管时，无论接受何种阻滞剂，10%的儿童T₄/T₁<0.9。当阻滞仍过深甚至已经恢复时，相当数量的患者肌松被错误地逆转。
