Department of Anesthesiology, Tokyo Medical and Dental University, Graduate School of Medicine, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan.
J Anesth. 2011 Dec;25(6):845-9. doi: 10.1007/s00540-011-1229-x. Epub 2011 Sep 21.
A train-of-four ratio (TOF ratio) of >0.9 should be the clinical cut-off to avoid residual paralysis. However, it is not rare to extubate patients without measurement of the TOF ratio, although the safe interval from the last administration of rocuronium assuring a TOF ratio of >0.9 has not been established in the daily clinical setting. In this study, to estimate the safe interval to avoid residual paralysis, we retrospectively selected patients in whom the TOF ratio was measured during remifentanil administration before extubation, and we studied the characteristics of recovery from the neuromuscular blockade produced by the empirical use of rocuronium.
Patients undergoing surgery under general anesthesia with sevoflurane and remifentanil were studied (n = 134). Rocuronium was administered at 0.7-1.0 mg/kg for tracheal intubation, and repeated bolus administration (10 mg) or continuous infusion (15-25 mg/h) was performed by the anesthesiologists in charge of the patient to maintain intraoperative paralysis. At the end of the surgery, the TOF ratio was measured, during remifentanil infusion and the contribution of clinical parameters to spontaneous recovery from the rocuronium-induced paralysis was studied by multivariate logistic regression analyses.
Spontaneous recovery from rocuronium-induced paralysis within 2 h after the last administration of rocuronium varied among the patients. Multivariate logistic regression analyses showed that age (P = 0.002) and time elapsed from the last administration of rocuronium (P < 0.0001) significantly contributed to TOF recovery, and elderly patients demonstrated significantly slower recovery.
Because of the large variation in the recovery from rocuronium-induced paralysis, TOF-based evaluation of residual paralysis is essential to determine the appropriate indication for reversal, especially for elderly patients.
TOF 比值（TOF 比值）>0.9 应作为避免残留麻痹的临床截止值。然而，在日常临床环境中，尚未确定确保 TOF 比值>0.9 的罗库溴铵最后一次给药后安全间隔时间，仍有不测量 TOF 比值就拔管的患者。在这项研究中，为了估计避免残留麻痹的安全间隔时间，我们回顾性选择了在拔管前测量瑞芬太尼输注期间 TOF 比值的患者，并研究了经验性使用罗库溴铵产生的神经肌肉阻滞恢复的特征。
研究了接受七氟醚和瑞芬太尼全身麻醉下手术的患者（n = 134）。罗库溴铵按 0.7-1.0mg/kg 用于气管插管，麻醉师负责重复给予推注（10mg）或连续输注（15-25mg/h）以维持术中麻痹。手术结束时，在瑞芬太尼输注期间测量 TOF 比值，并通过多元逻辑回归分析研究临床参数对罗库溴铵诱导的麻痹自发恢复的贡献。
罗库溴铵最后一次给药后 2 小时内，患者的罗库溴铵诱导的麻痹自发恢复情况各不相同。多元逻辑回归分析显示，年龄（P=0.002）和罗库溴铵最后一次给药后时间（P<0.0001）对 TOF 恢复有显著影响，老年患者的恢复明显较慢。
由于罗库溴铵诱导的麻痹恢复差异很大，TOF 评估残留麻痹对于确定逆转的适当适应证至关重要，尤其是对于老年患者。
