Majekodunmi A A, Ikotun O A, Oladokun O D
Department of Anaesthesia, Lagos State University College of Medicine, Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria.
Niger J Clin Pract. 2017 Dec;20(12):1561-1565. doi: 10.4103/njcp.njcp_99_17.
Postoperative residual paralysis (PORP) is a known risk factor after general anesthesia (GA) for critical respiratory events and increased postoperative morbidity. PORP is defined as a train-of-four ratio (TOFR) of <0.9 using acceleromyography (AMG). TOFR <0.9 has been associated with increased risk of aspiration, obstruction of the upper airway and an impaired hypoxic ventilatory response.
The aim of this study was to determine the incidence of PORP, associated factors related with its occurrence and critical respiratory events in the postanesthesia recovery room (PAR) at our institution.
Forty-one adult patients were scheduled for elective surgeries requiring GA with the use of at least 1 dose of a nondepolarizing neuromuscular blocking drug (NMBD). An independent anesthetist quantitatively measured TOFR of recruited patients postoperatively in the recovery room using the TOF-watch SX acceleromyograph (Organon Teknika) 5 min after arrival.
The incidence of PORP was 75.6% (n = 31), with severe PORP (TOFR <0.7) seen in 41.5% (n = 17) of patients. Median time to full recovery in the PAR was 33 min (range 5-164 min). There was no statistical difference in the incidence of PORP related to the choice of NMBD (P = 0.186) or duration of surgery (P = 0.175). No respiratory complications or events were observed in patients with residual blockade.
The incidence of PORP is quite high and undetected in our environment. Quantitative monitoring for residual paralysis is advocated as part of routine monitoring with the use of NMBDs for improved patient safety.
术后残余麻痹（PORP）是全身麻醉（GA）后发生严重呼吸事件及术后发病率增加的一个已知风险因素。PORP定义为使用加速度肌电图（AMG）时四个成串刺激比值（TOFR）<0.9。TOFR<0.9与误吸风险增加、上呼吸道梗阻及低氧通气反应受损相关。
本研究的目的是确定我院麻醉后恢复室（PAR）中PORP的发生率、与其发生相关的因素以及严重呼吸事件。
41例成年患者计划接受择期手术，需要使用至少一剂非去极化神经肌肉阻滞剂（NMBD）进行全身麻醉。一名独立麻醉医生在患者术后抵达恢复室5分钟后，使用TOF-watch SX加速度肌电图仪（欧加农公司）对入选患者的TOFR进行定量测量。
PORP的发生率为75.6%（n = 31），41.5%（n = 17）的患者出现严重PORP（TOFR<0.7）。PAR中完全恢复的中位时间为33分钟（范围5 - 164分钟）。与NMBD的选择（P = 0.186）或手术时间（P = 0.175）相关的PORP发生率无统计学差异。残余阻滞患者未观察到呼吸并发症或事件。
在我们的环境中，PORP的发生率相当高且未被察觉。提倡将残余麻痹的定量监测作为使用NMBD进行常规监测的一部分，以提高患者安全性。
