Section of Anaesthesia and Intensive Care Medicine, Department of Medicine, Padua University Hospital, Via Battisti, 267, 35121 Padua, Italy.
Section of Anaesthesia and Intensive Care Medicine, Department of Medicine, Padua University Hospital, Via Battisti, 267, 35121 Padua, Italy.
J Clin Anesth. 2016 Dec;35:198-204. doi: 10.1016/j.jclinane.2016.07.031. Epub 2016 Sep 7.
Postoperative residual neuromuscular blockade (RNMB) is a common complication in the postanesthesia care unit (PACU), but also one of the most controversial issues. Many studies and trials demonstrated that some methods and techniques can reduce the incidence and the extent of the phenomenon.
To determine the incidence of RNMB in the PACU at standardized times after extubation with the implementation of a protocol of careful neuromuscular blockade management.
Randomized, single-blinded controlled clinical trial.
Operating room and PACU.
A total of 120 patients of either sex with American Society of Anesthesiologists grades 1, 2, and 3, aged 18 to 80 years were scheduled to undergo elective abdominal surgical procedures lasting for at least 60 minutes.
Patients were randomized to receive either cisatracurium (n=60) or rocuronium (n=60) at the time of intubation and during surgery. Every patient received quantitative neuromuscular monitoring during general anesthesia. On completion of surgery, patients were given neostigmine 0.05 mg kg. Patients were extubated at a train-of-four (TOF) ratio≥0.9.
TOF measurements were performed 15, 30, and 60 minutes after extubation. Tolerability of neuromuscular monitoring was evaluated with a scale from 1 to 10 (with 1 meaning no discomfort at all and 10 meaning maximal discomfort or pain).
Six, 11, and 14 patients (5.0%, 9.2%, and 11.7%) exhibited a TOF ratio <0.9 at 15, 30, and 60 minutes after extubation, respectively. No statistically significant difference in the postoperative RNMB between cisatracurium and rocuronium was found. The median tolerability score for neuromuscular monitoring was 3.
Careful conduction, monitoring, and subsequent reversal of neuromuscular block may allow for obtaining considerably low incidence of residual neuromuscular block. However, our trial shows that some mid- and long-term cases of TOF ratios <0.9 can still occur, possibly jeopardizing the patients' postoperative recovery.
术后残余神经肌肉阻滞(RNMB)是麻醉后恢复室(PACU)中的常见并发症,但也是最具争议的问题之一。许多研究和试验表明,某些方法和技术可以降低其发生率和程度。
在标准化拔管后通过实施精心的神经肌肉阻滞管理方案,确定 PACU 中 RNMB 的发生率。
随机、单盲对照临床试验。
手术室和 PACU。
共纳入 120 例性别、美国麻醉医师协会(ASA)分级 1、2 和 3 级、年龄 18~80 岁的择期腹部手术患者,手术持续时间至少 60 分钟。
患者随机接受插管时和手术期间给予顺式阿曲库铵(n=60)或罗库溴铵(n=60)。每位患者在全身麻醉期间均接受定量神经肌肉监测。手术结束时,患者给予新斯的明 0.05mg/kg。TOF 比值≥0.9 时拔管。
拔管后 15、30 和 60 分钟进行 TOF 测量。使用 1~10 的量表评估神经肌肉监测的耐受性(1 表示无任何不适,10 表示最大不适或疼痛)。
分别有 6、11 和 14 例患者(5.0%、9.2%和 11.7%)在拔管后 15、30 和 60 分钟时出现 TOF 比值<0.9。顺式阿曲库铵和罗库溴铵之间术后 RNMB 无统计学显著差异。神经肌肉监测的中位耐受性评分为 3。
精心进行、监测和随后逆转神经肌肉阻滞可能会使残余神经肌肉阻滞的发生率显著降低。然而,我们的试验表明,TOF 比值<0.9 的一些中、长期病例仍可能发生,这可能会危及患者的术后恢复。