新斯的明与舒更葡糖在减重手术后的术后恢复情况比较。

Neostigmine versus sugammadex on post-operative recovery following bariatric surgery.

作者信息

Ekinci Osman, Gulmez Duygu Demiriz, Subasi Ferhunde Dilek, Ozgultekin Asu, Demiroluk Oznur

机构信息

Department of Anesthesiology and Reanimation, University of Health Sciences, Haydarpasa Numune Training and Research Hospital, Istanbul, Turkiye.

Department of Anesthesiology and Reanimation, Giresun University Faculty of Medicine, Giresun, Turkiye.

出版信息

North Clin Istanb. 2022 Aug 16;9(4):311-316. doi: 10.14744/nci.2021.94715. eCollection 2022.

DOI:10.14744/nci.2021.94715

PMID:36276569

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9514077/

Abstract

OBJECTIVE

The purpose of our study was to compare the recovery characteristics and side effects of sugammadex (SM) and neostigmine (NT) in morbidly obese patients undergoing bariatric surgery. Residual neuromuscular block is a serious condition that increases pulmonary complications after anesthesia. Although acetylcholinesterase inhibitors help reverse this block, they may be insufficient, especially when administered with inhalational anesthetics. SM, a selective antagonist, may be more effective in reversing the block.

METHODS

Patients were randomly divided into NT group (Group NT, n=34) and SM group (Group SM, n=34).For the induction, fentanil (1-1.5 µ/kg), propofol (2-3 mg/kg), and rocuronium (0.6 mg/kg) were used.For the maintenance, 50% O + air, 1% sevoflurane, and remifentanil (0.5-0.3 µg/kg/min) were used. Additional rocuronium was given to maintain the train of four (TOF) ratio ≤2. On completion of surgery and when the TOF ratio was 2, group NT received 50 µg/kg of NT with 20 µg/kg of atropine, whereas group SM received 2 mg/kg of SM. Hemodynamic parameters and peripheral oxygen saturation (SpO) were recorded every 10 minfirst, and every 5 min after the reversal agents were given. When the TOF ratio was 0.9 or higher, time to reach a TOF ratio of 0.9, and time to extubation were recorded. Patients were observed in the recovery room for 30 min for adverse effects.

RESULTS

Demographic characteristics of the patients and total rocuronium use in two groups were similar (p>0.05).Time to extubation, time to TOF ratio of 0.9, time until patients responded to stimuli, time until cooperation, and time until orientation were significantly shorter in the SM group than in the NT group. Time to reach the Aldrete score of 9 was also significantly shorter in the SM group (p<0.05).In the post-operative period, hemodynamic variables and side effects such asrespiratory difficulty, nausea, vomiting, hypo/hypertension, and presence of pain showed no statistically significant differences between the groups (p>0.05).

CONCLUSION

Considering the high risk of post-operative respiratory insufficiency inmorbidly obese patients, SM could be a safer choice in this patient group.

摘要

目的

我们研究的目的是比较舒更葡糖钠（SM）和新斯的明（NT）在接受减肥手术的病态肥胖患者中的恢复特征和副作用。残余神经肌肉阻滞是一种严重情况，会增加麻醉后肺部并发症的发生。尽管乙酰胆碱酯酶抑制剂有助于逆转这种阻滞，但可能并不充分，尤其是与吸入性麻醉剂合用时。SM作为一种选择性拮抗剂，可能在逆转阻滞方面更有效。

方法

将患者随机分为NT组（NT组，n = 34）和SM组（SM组，n = 34）。诱导时使用芬太尼（1 - 1.5μg/kg）、丙泊酚（2 - 3mg/kg）和罗库溴铵（0.6mg/kg）。维持时使用50%氧气 + 空气、1%七氟醚和瑞芬太尼（0.5 - 0.3μg/kg/min）。给予额外的罗库溴铵以维持四个成串刺激（TOF）比值≤2。手术结束且TOF比值为2时，NT组给予50μg/kg的NT加20μg/kg的阿托品，而SM组给予2mg/kg的SM。首先每10分钟记录一次血流动力学参数和外周血氧饱和度（SpO），给予逆转剂后每5分钟记录一次。当TOF比值达到0.9或更高时，记录达到TOF比值0.9的时间和拔管时间。在恢复室观察患者30分钟以观察不良反应。

结果

两组患者的人口统计学特征和罗库溴铵总用量相似（p>0.05）。SM组的拔管时间、达到TOF比值0.9的时间、患者对刺激有反应的时间、合作的时间和定向的时间均显著短于NT组。SM组达到Aldrete评分为9的时间也显著更短（p<0.05）。术后，两组之间的血流动力学变量和副作用如呼吸困难、恶心、呕吐、低血压/高血压以及疼痛情况在统计学上无显著差异（p>0.05）。