Department of Anesthesia and Intensive Care Medicine, KKH Dormagen, Dormagen, Germany.
Klinik für Anästhesie, Intensiv- und Notfallmedizin, Kreiskrankenhaus Dormagen, D-41540, Dormagen, Germany.
BMC Anesthesiol. 2017 Aug 17;17(1):106. doi: 10.1186/s12871-017-0401-8.
Adequate muscle relaxation is important for ensuring optimal conditions for intubation. Although acceleromyography of the adductor pollicis muscle is commonly used to assess conditions for intubation, we hypothesized that acceleromyography of the trapezius is more indicative of optimal intubating conditions. The primary outcome was the difference between both measurement sites with regard to prediction of good or acceptable intubating conditions.
Neuromuscular blockade after injection of rocuronium 0.3 mg/kg IV was measured simultaneously with acceleromyography of the adductor pollicis muscle and the trapezius muscle in sixty female patients, American Society of Anesthesiologists physical status I to III, undergoing general anesthesia for gynecologic surgery. Exclusion criteria were: expected difficult tracheal intubation (e.g. history of difficult intubation, reduced mouth opening (< 2 cm) and/or Mallampati Score 4), increased risk of pulmonary aspiration (e.g. gastroesophageal reflux or delayed gastric emptying) allergies to drugs used during the study, pregnancy, neuromuscular diseases, medication with potential to influence neuromuscular function (e.g. furosemide, magnesium, cephalosporins) and hepatic or renal insufficiency (serum bilirubin >26 μmol/L, serum creatinine >90 μmol/l). Patients were randomized to 2 groups: group A (n = 30): endotracheal intubation after onset of the neuromuscular block at the adductor pollicis muscle. Group B (n = 30): endotracheal intubation after onset at the trapezius muscle. Intubating conditions were compared between both groups by means of a standardised score (the Copenhagen score) with Fisher's exact test.
Onset of the block after rocuronium injection was observed at the adductor pollicis muscle compared to the trapezius with 2.8 (1.1) versus 2.5 (1.1) min (mean ± SD; P = 0.006). Intubating conditions were poor in 2 patients (7%) of group A, and in 1 patient (3%) of group T. They were acceptable (either excellent or good) in 28 patients (93%) in group A, and in 1 patient (97%) in group T (P = 0.82).
Performing acceleromyography at the trapezius muscle reduced the time between injection of neuromuscular blocking agents and intubation by 18 s (11%). Thus, trapezius muscle acceleromyography is an acceptable alternative to adductor pollicis muscle acceleromyography in predicting acceptable intubating conditions, which allows for earlier indication of adequate intubating conditions.
ClinicalTrial.gov Identifier: NCT01849198 . Registered April 29, 2013.
充分的肌肉松弛对于确保插管的最佳条件非常重要。虽然拇内收肌的加速度描记术常用于评估插管条件，但我们假设斜方肌的加速度描记术更能预测最佳插管条件。主要结局是两个测量部位在预测良好或可接受的插管条件方面的差异。
在 60 名接受妇科手术全身麻醉的美国麻醉医师协会身体状况 I 至 III 级的女性患者中，同时测量拇内收肌和斜方肌的加速度描记术，以及罗库溴铵 0.3mg/kg IV 注射后的神经肌肉阻滞。排除标准为：预计气管插管困难（例如插管困难史、张口度减小（<2cm）和/或 Mallampati 评分 4）、增加肺吸入风险（例如胃食管反流或胃排空延迟）、对研究期间使用的药物过敏、怀孕、神经肌肉疾病、可能影响神经肌肉功能的药物（例如呋塞米、镁、头孢菌素）以及肝或肾功能不全（血清胆红素>26μmol/L，血清肌酐>90μmol/L）。患者随机分为 2 组：A 组（n=30）：拇内收肌神经肌肉阻滞后行气管插管。B 组（n=30）：斜方肌神经肌肉阻滞后行气管插管。通过标准化评分（哥本哈根评分）和 Fisher 确切检验比较两组之间的插管条件。
罗库溴铵注射后，与拇内收肌相比，斜方肌的阻滞起效时间为 2.8（1.1）比 2.5（1.1）分钟（均数±标准差；P=0.006）。A 组有 2 名患者（7%）插管条件较差，B 组有 1 名患者（3%）插管条件较差。A 组 28 名患者（93%）和 B 组 1 名患者（97%）的插管条件可接受（极好或良好）（P=0.82）。
在斜方肌上进行加速度描记术可使神经肌肉阻滞剂注射与插管之间的时间缩短 18 秒（11%）。因此，斜方肌加速度描记术可替代拇内收肌加速度描记术来预测可接受的插管条件，从而更早地提示插管条件已充分。
ClinicalTrials.gov 标识符：NCT01849198。于 2013 年 4 月 29 日注册。
