罗库溴铵用于 60 至 80 岁患者肌松监测时，预刺激强直刺激对肌颤搐反应稳定时间的影响：一项前瞻性随机对照试验。

Effect of tetanic stimulation prior to train-of-four monitoring on the time to muscle response stabilization with neuromuscular blockade with rocuronium in patients aged 60 to 80 years: A prospective randomized controlled trial.

机构信息

Department of General Specialized Surgery, Postgraduate Program in Medical Science, Universidade Federal Fluminense (UFF), Niterói, RJ, Brazil.

Department of Surgery, Postgraduate Program in Surgical Sciences, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil.

出版信息

PLoS One. 2024 Jun 14;19(6):e0303161. doi: 10.1371/journal.pone.0303161. eCollection 2024.

DOI:10.1371/journal.pone.0303161

PMID:38875248

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11178177/

Abstract

PURPOSE

To determine the effect of tetanic stimulation on the time to achieve stabilization of the T1 height, by acceleromyography train-of-four (TOF) ratio monitoring, in patients aged 60 to 80 years.

METHODS

Randomized, prospective, single-blind, controlled trial in patients aged 60 to 80 years undergoing elective surgery under general anesthesia in two university hospitals in Brazil between December 2019 and March 2022. This trial was performed in accordance with the principles of the Helsinki Declaration and the guidelines for good clinical research practice in pharmacodynamic studies of neuromuscular blocking agents II. Participants were randomly allocated by computer-generated numbers to receive tetanic stimulation (intervention group, n = 25) or not receive tetanic stimulation (control group, n = 25) to achieve T1 height stabilization on TOF ratio monitoring. The primary endpoint was to evaluate the effect of tetanic stimulation on the time to achieve stabilization of the T1 height. We also evaluated the effect on the onset time of rocuronium and time to recover from neuromuscular blockade with a single dose of rocuronium 0.6 mg.kg-1 with spontaneous recovery.

RESULTS

There was no statistically significant difference between the groups in the time to T1 height stabilization (intervention: 4.3 [2.0-8.0] min; control: 5.8 [2.0-10.5] min; p = 0.202), onset time of the neuromuscular blocking agent (intervention: 1.9 [±0.7] min; control: 2.2 [±1.0] min; p = 0.219), or neuromuscular blockade recovery times to normalized TOF values of 0.7 (intervention: 106.1 [±37.2] min; control: 91.7 [±27.5] min; p = 0.295), 0.8 (intervention: 114.3 [±40.1] min; control: 97.8 [±28.9] min; p = 0.225), 0.9 (intervention: 126.5 [±44.0] min; control: 106.9 [±30.6] min; p = 0.153), and 1.0 (intervention: 138.3 [±43.4] min; control: 123.8 [±43.5] min; p = 0.425).

CONCLUSION

The results of this study suggest that the recommendation to use tetanic stimulation to shorten the time to T1 height stabilization in neuromuscular monitoring did not alter the stabilization time of the T1 twitch or the pharmacodynamics of neuromuscular blockade with rocuronium in patients aged 60 to 80 years.

摘要

目的

通过加速度肌描记术（TOF）比监测，确定在 60 至 80 岁的患者中，强直刺激对 T1 高度稳定所需时间的影响。

方法

这是 2019 年 12 月至 2022 年 3 月期间，在巴西两所大学医院接受全身麻醉下择期手术的 60 至 80 岁患者的随机、前瞻性、单盲、对照试验。该试验符合《赫尔辛基宣言》的原则和神经肌肉阻滞剂药效学研究的良好临床研究实践指南 II。通过计算机生成的数字将参与者随机分配至接受强直刺激（干预组，n=25）或不接受强直刺激（对照组，n=25）以在 TOF 比监测中实现 T1 高度稳定。主要终点是评估强直刺激对 T1 高度稳定所需时间的影响。我们还评估了强直刺激对罗库溴铵起效时间和单次给予 0.6mg.kg-1罗库溴铵后神经肌肉阻滞恢复时间的影响，在恢复过程中，T1 高度自发恢复。

结果

在 T1 高度稳定所需时间方面，两组间无统计学差异（干预组：4.3[2.0-8.0]min；对照组：5.8[2.0-10.5]min；p=0.202）、神经肌肉阻滞剂的起效时间（干预组：1.9[±0.7]min；对照组：2.2[±1.0]min；p=0.219）或神经肌肉阻滞恢复至 TOF 值为 0.7（干预组：106.1[±37.2]min；对照组：91.7[±27.5]min；p=0.295）、0.8（干预组：114.3[±40.1]min；对照组：97.8[±28.9]min；p=0.225）、0.9（干预组：126.5[±44.0]min；对照组：106.9[±30.6]min；p=0.153）和 1.0（干预组：138.3[±43.4]min；对照组：123.8[±43.5]min；p=0.425）时的恢复时间。