Goyal Shilpa, Kothari Nikhil, Chaudhary Deepak, Verma Shilpi, Bihani Pooja, Rodha Mahaveer Singh
Department of Anaesthesiology and Critical Care, AIIMS, Jodhpur, Rajasthan, India.
Trauma and Emergency, AIIMS, Jodhpur, Rajasthan, India.
Indian J Anaesth. 2018 Mar;62(3):219-224. doi: 10.4103/ija.IJA_652_17.
In clinical practice, in the majority of patients, recovery from the effect of muscle relaxants is assessed using subjective methods such as head lift, eye-opening, or by sustained hand grip after giving anticholinesterases (neostigmine) at the end of surgery. We planned a prospective observational cohort study to test the hypothesis that objective neuromuscular monitoring can help us in avoiding the use of anticholinesterases for reversal.
The patients posted for surgery of <2 h duration were included in the study. The cohort of patients was formed on the basis of those who were exposed to objective neuromuscular monitoring of recovery (train-of-four [TOF] ratio of 0.9 or more; exposed group) and the patients who were not exposed to objective neuromuscular monitoring (non-exposed group) acting as a control. Using objective neuromuscular monitoring, the time required for recovery from muscle relaxation when neostigmine was not given for reversal was noted and it was then compared with that of the control group.
A total of 190 patients were enrolled over a period of 3 years. With the use of TOF ratio of 0.9 for extubation, patients safely recovered from neuromuscular blockade, without using neostigmine, with no difference in the mean recovery time (14.48 ± 1.138 min) as compared to the control group (12.14 ± 1.067 min, = 0.139). There was no incidence of reintubation in post-operative period.
With objective neuromuscular monitoring, we can ensure complete recovery from the neuromuscular blockade while avoiding the use of anticholinesterases.
在临床实践中，对于大多数患者，在手术结束时给予抗胆碱酯酶药（新斯的明）后，通过抬头、睁眼等主观方法或持续握力来评估肌肉松弛药作用的恢复情况。我们计划开展一项前瞻性观察性队列研究，以检验客观神经肌肉监测有助于避免使用抗胆碱酯酶药进行逆转的假设。
纳入计划进行时长小于2小时手术的患者。根据是否接受恢复情况的客观神经肌肉监测（四个成串刺激[TOF]比值达到0.9或更高；暴露组）将患者分为队列，未接受客观神经肌肉监测的患者（非暴露组）作为对照。使用客观神经肌肉监测，记录在不给予新斯的明进行逆转时从肌肉松弛恢复所需的时间，并与对照组进行比较。
在3年期间共纳入190例患者。采用TOF比值为0.9进行拔管时，患者在未使用新斯的明的情况下安全地从神经肌肉阻滞中恢复，与对照组相比平均恢复时间无差异（14.48±1.138分钟 vs 12.14±1.067分钟，P = 0.139）。术后无再次插管的情况发生。
通过客观神经肌肉监测，我们可以确保从神经肌肉阻滞中完全恢复，同时避免使用抗胆碱酯酶药。
