Department of Anaesthesiology, Centre of Head and Orthopaedics, Section 6011, Copenhagen University Hospital - Rigshospitalet, Denmark.
Dan Med J. 2024 May 13;71(6):A09230578. doi: 10.61409/A09230578.
The effect of neuromuscular blocking agents may be reversed by administration of neostigmine, when two twitches are present using train-of-four (TOF) stimulation. However, in elderly patients, limited data are available about when to administer neostigmine. We hypothesised that time to two twitches after TOF (TOF-2) was shorter after rocuronium 0.6 mg/kg than after rocuronium 0.9 mg/kg. Also, we hypothesised that time to TOF-2 would be shorter after rocuronium 0.3 mg/kg than after rocuronium 0.6 mg/kg.
This was a secondary analysis of 50 elderly patients > 80 years; 16 patients received rocuronium 0.6 mg/kg, another 16 patients received rocuronium 0.9 mg/kg; and, finally, 18 patients received rocuronium 0.3 mg/kg. Patients received total intravenous anaesthesia, and neuromuscular block was monitored with acceleromyography.
Time to TOF-2 was shorter after rocuronium 0.6 mg/kg than after rocuronium 0.9 mg/kg: 37 min. versus 59 min. (difference: 22 min. (95% confidence intervals (CI): 10 to 33 min.), p = 0.0007). Time to TOF-2 after rocuronium 0.3 mg/kg was shorter than after rocuronium 0.6 mg/kg: 19 min. versus 37 min. (difference: 18 min. (95% CI: 11 to 25 min.), p = 0.00006). However, only 33% of the patients receiving 0.3 mg/kg obtained full effect i.e. TOF-0.
Time to TOF-2 was shorter after rocuronium 0.6 mg/kg than after 0.9 mg/kg and shorter after rocuronium 0.3 mg/kg than after 0.6 mg/kg.
This work was supported by departmental sources.
This study was a secondary analysis of two clinical trials.
gov (NCT04512313), (NCT03857750).
当使用四脉冲刺激（TOF）时，存在两个抽搐时，给予新斯的明可逆转神经肌肉阻滞剂的作用。然而，在老年患者中，关于何时给予新斯的明的数据有限。我们假设，TOF 后出现两个抽搐的时间（TOF-2）在罗库溴铵 0.6mg/kg 时比罗库溴铵 0.9mg/kg 时更短。此外，我们假设，TOF-2 的时间在罗库溴铵 0.3mg/kg 时比罗库溴铵 0.6mg/kg 时更短。
这是对 50 名年龄大于 80 岁的老年患者的二次分析；16 名患者接受罗库溴铵 0.6mg/kg，另 16 名患者接受罗库溴铵 0.9mg/kg，最后 18 名患者接受罗库溴铵 0.3mg/kg。患者接受全静脉麻醉，肌电图监测神经肌肉阻滞。
罗库溴铵 0.6mg/kg 时 TOF-2 的时间短于罗库溴铵 0.9mg/kg：37min 与 59min（差异：22min（95%置信区间（CI）：10-33min），p=0.0007）。罗库溴铵 0.3mg/kg 时 TOF-2 的时间短于罗库溴铵 0.6mg/kg：19min 与 37min（差异：18min（95%CI：11-25min），p=0.00006）。然而，只有 33%接受 0.3mg/kg 的患者获得完全效果，即 TOF-0。
罗库溴铵 0.6mg/kg 时 TOF-2 的时间短于 0.9mg/kg，罗库溴铵 0.3mg/kg 时短于 0.6mg/kg。
这项工作得到了部门来源的支持。
这项研究是两项临床试验的二次分析。
gov（NCT04512313），（NCT03857750）。
