Esteves Simão, Correia de Barros Filinto, Nunes Catarina S, Puga Andreia, Gomes Blandina, Abelha Fernando, Machado Humberto, Ferreira Milene, Fernandes Nuno, Vítor Paula, Pereira Sandra, Lapa Teresa A, Pinho-Oliveira Vítor
Anesthesiology Service, Centro Hospitalar Universitário do Porto, Porto, Portugal.
Departamento de Ciências e Tecnologia Universidade Aberta, Delegação do Porto and Anesthesiology Service, Centro Hospitalar Universitário do Porto, Porto, Portugal.
Porto Biomed J. 2023 Aug 3;8(4):e225. doi: 10.1097/j.pbj.0000000000000225. eCollection 2023 Jul-Aug.
Although the use of neuromuscular blocking agents (NMBAs) optimizes surgical conditions and facilitates tracheal intubation, it can lead to residual neuromuscular blockade (RNMB), with postoperative complications. This study aimed to assess RNMB incidence and management in Portugal.
Prospective observational study of patients admitted for elective surgery requiring general anesthesia with nondepolarizing NMBAs between July 2018 and July 2019 at 10 Portuguese hospitals. The primary endpoint was the proportion of patients arriving at postanesthesia care unit (PACU) with a TOF ratio <0.9.
A total of 366 patients were included, with a median age of 59 years, and 89.1% classified as ASA II or III. Rocuronium was the most used NMBA (99.5%). A total of 96.2% of patients received a reversal agent, 96.6% of which sugammadex and 3.4% neostigmine. Twenty patients displayed a TOF ratio <0.9 at PACU arrival, representing an RNMB incidence of 5.5% (95% CI, 3.1%-7.8%). Only two patients displayed a TOF ratio <0.7. RNMB incidence was 16.7% with neostigmine and 5.3% with sugammadex ( = .114). In patients with intraoperative neuromuscular blockade (NMB) monitoring, RNMB incidence was 5% (95% CI, 2%-8%), which varied significantly according to the type of monitoring ( = .018). Incidence of adverse events was 3.3% (2 severe and 10 moderate).
The reported overall incidence of 5.5% is numerically lower than results from similar observational studies. An appropriate pharmacological neuromuscular reversal strategy, guided by quantitative neuromuscular monitoring, has the potential to achieve even better results, converting RNMB from an unusual to a very rare or even inexistent event.
尽管使用神经肌肉阻滞剂（NMBAs）可优化手术条件并便于气管插管，但可能导致残余神经肌肉阻滞（RNMB）及术后并发症。本研究旨在评估葡萄牙的RNMB发生率及处理情况。
对2018年7月至2019年7月期间在葡萄牙10家医院接受需要使用非去极化NMBAs的全身麻醉的择期手术患者进行前瞻性观察研究。主要终点是到达麻醉后护理单元（PACU）时TOF比值<0.9的患者比例。
共纳入366例患者，中位年龄59岁，89.1%被归类为ASA II或III级。罗库溴铵是最常用的NMBA（99.5%）。共有96.2%的患者接受了逆转剂，其中96.6%使用舒更葡糖钠，3.4%使用新斯的明。20例患者到达PACU时TOF比值<0.9，RNMB发生率为5.5%（95%CI，3.1%-7.8%）。仅2例患者TOF比值<0.7。新斯的明组RNMB发生率为16.7%，舒更葡糖钠组为5.3%（P = 0.114）。在术中进行神经肌肉阻滞（NMB）监测的患者中，RNMB发生率为5%（95%CI，2%-8%），根据监测类型有显著差异（P = 0.018）。不良事件发生率为3.3%（2例严重，10例中度）。
报告的总体发生率5.5%在数值上低于类似观察性研究的结果。在定量神经肌肉监测的指导下，适当的药理学神经肌肉逆转策略有可能取得更好的效果，使RNMB从一种不常见事件转变为非常罕见甚至不存在的事件。
