Department of Anesthesiology, Nihon University School of Medicine, 30-1, Oyaguchi-Kamicho, Itabashi-Ku, Tokyo, 173-8610, Japan.
J Anesth. 2020 Dec;34(6):876-880. doi: 10.1007/s00540-020-02831-6. Epub 2020 Jul 23.
To prevent coughing related to tracheal intubation and the resultant exposure of intubating staff to the patients' expiratory aerosols, the timing of tracheal intubation needs to be precisely predicted. The aim of this study was to evaluate the hypothesis that the timing for safe tracheal intubation in elderly patients can be determined by acceleromyographically monitoring paralysis of the adductor pollicis muscle when high-dose rocuronium, given to block the respiratory muscles, is administered.
Forty elderly (65-92 years) patients were enrolled in this study and randomly assigned to two groups, to receive rocuronium 0.6 mg/kg or 1 mg/kg. After induction of anesthesia and observing acceleromyographic train-of-four (TOF) responses of the adductor pollicis muscle to ulnar nerve stimulation, the patients randomly received either dose of rocuronium. The onset times from rocuronium administration to TOF counts of 0 were measured. Soon thereafter, a single anesthesiologist who was blinded to the allocated dose of rocuronium performed laryngoscopy and tracheal intubation, and assessed intubating conditions. Data were analyzed by the unpaired t-test and Chi-squared test.
The averaged [SD] onset time of neuromuscular blockade was significantly shorter with 1 mg/kg than 0.6 mg/kg rocuronium (104.3 [30.1] s vs. 186.8 [37.5] s, p < 0.001). Patients who received 0.6 mg/kg rocuronium variously showed either poor (n = 9) or good (n = 11) intubating conditions. However, all patients who received 1 mg/kg rocuronium had excellent intubating conditions.
If 1 mg/kg rocuronium is administered, a TOF count of 0 acceleromyographically observed at the adductor pollicis muscle can reveal the adequate timing for tracheal intubation.
为了防止气管插管引起的咳嗽和由此导致的插管人员暴露于患者的呼出气溶胶中，需要准确预测气管插管的时间。本研究旨在评估以下假设，即当给予高剂量罗库溴铵阻断呼吸肌时，通过加速肌描记法监测内收拇指肌的麻痹，可以确定老年患者进行安全气管插管的时间。
本研究纳入了 40 名老年（65-92 岁）患者，并将其随机分为两组，分别接受 0.6mg/kg 或 1mg/kg 的罗库溴铵。在麻醉诱导并观察到尺神经刺激对内收拇指肌的加速肌描记四（TOF）反应后，患者随机接受两种剂量的罗库溴铵。测量从罗库溴铵给药到 TOF 计数为 0 的起始时间。此后，一位对罗库溴铵分配剂量不知情的单独麻醉师进行喉镜检查和气管插管，并评估插管条件。数据通过未配对 t 检验和卡方检验进行分析。
1mg/kg 罗库溴铵的神经肌肉阻滞起始时间明显短于 0.6mg/kg 罗库溴铵（104.3[30.1]s 比 186.8[37.5]s，p<0.001）。接受 0.6mg/kg 罗库溴铵的患者插管条件各不相同，或差（n=9）或好（n=11）。然而，所有接受 1mg/kg 罗库溴铵的患者插管条件均极佳。
如果给予 1mg/kg 罗库溴铵，内收拇指肌的 TOF 计数为 0 加速肌描记法观察到的可以揭示气管插管的适当时间。
