Khanna Puneet, Das Aditi, Sarkar Soumya
Department of Anaesthesia, Pain Medicine and Critical Care, AIIMS, New Delhi, India.
Department of Paediatric Medicine, Kalawati Saran Children's Hospital, New Delhi, India.
J Anaesthesiol Clin Pharmacol. 2024 Jan-Mar;40(1):15-21. doi: 10.4103/joacp.joacp_139_22. Epub 2023 Apr 7.
Postoperative residual curarization (PORC) and the impact of the coadministration of intravenous calcium along with an acetylcholinesterase inhibitor on it are not well addressed. Extensive electronic database screening was done until October 7, 2022 after enlisting the protocol of this systematic review in PROSPERO (CRD42021274879). Randomized controlled trials (RCTs) evaluating the impact of intravenous calcium and neostigmine coadministration on neuromuscular recovery were included in this meta-analysis. Our search retrieved four RCTs with a total of 266 patients. The application of calcium shortened the neuromuscular recovery time (SMD = -2.13, 95% confidence interval [CI]: -2.66 to -1.59, = 66%) and reduced the risk of PORC at 5 min (odds ratio [OR] = 0.21, 95% CI: 0.10-0.46, = 0%), with an improved train-of-four (TOF) ratio at 5 min (mean difference [MD] = 9.28, 95% CI: 4-14.57, = 66%). However, neither significant reduction in PORC at 10 min (OR = 0.41, 95% CI: 0.15-1.09, = 0%) nor a better TOF ratio was associated with coadministration of calcium (MD = 0.40, 95% CI: -1.3-2.11). Coadministration of calcium along with neostigmine during the early period of neuromuscular blockade reversal can be used to enhance neuromuscular recovery.
术后残余肌松（PORC）以及静脉注射钙与乙酰胆碱酯酶抑制剂联合使用对其的影响尚未得到充分研究。在将本系统评价方案登记到PROSPERO（CRD42021274879）之后，我们进行了广泛的电子数据库筛选，直至2022年10月7日。本荟萃分析纳入了评估静脉注射钙与新斯的明联合使用对神经肌肉恢复影响的随机对照试验（RCT）。我们的检索共获得4项RCT，涉及266例患者。钙的应用缩短了神经肌肉恢复时间（标准化均数差[SMD]=-2.13，95%置信区间[CI]：-2.66至-1.59，P=66%），并降低了5分钟时PORC的风险（比值比[OR]=0.21，95%CI：0.10-0.46，P=0%），5分钟时四个成串刺激（TOF）比值有所改善（均数差[MD]=9.28，95%CI：4-14.57，P=66%）。然而，钙联合使用在10分钟时并未显著降低PORC（OR=0.41，95%CI：0.15-1.09，P=0%），且TOF比值也未改善（MD=0.40，95%CI：-1.3-2.11）。在神经肌肉阻滞逆转早期，钙与新斯的明联合使用可用于促进神经肌肉恢复。
