Rani M Vidya, Faiaz Afra Farheen, Banakara Shanthala K, Nk Jyothsna Gopinathan, Khan Mohammed Inayathulla, H C Sunil, Yeli Ravi Kumar
Department of Anesthesiology, Kanachur Institute of Medical Sciences, Mangalore, IND.
Department of Anesthesiology, Patil Ortho and Trauma Centre, Ilkal, IND.
Cureus. 2024 Aug 13;16(8):e66767. doi: 10.7759/cureus.66767. eCollection 2024 Aug.
Background Neuromuscular blocking agents are crucial for anesthesia but can cause reversible paralysis, leading to risks like postoperative residual dysfunction. Undetected paralysis in the post-anesthesia care unit (PACU) jeopardizes patient safety by impairing airway function and increasing complications. Effective reversal, assessed clinically or via nerve stimulation, is critical to prevent residual postoperative curarization (RPOC), which is linked to significant morbidity and mortality. Evaluating agents like rocuronium and cisatracurium helps optimize anesthesia outcomes and patient recovery. Methodology The study included 100 American Society of Anaesthesiologists (ASA) I and II patients approved by the Institutional Review Board of Kasturba Medical College, Mangalore, India. Patients were briefed about the study, provided written informed consent, and underwent pre-anesthetic evaluations, including discussions on anesthetic procedures and associated risks. They were instructed to fast overnight after consenting. Results The study compared 100 ASA I and II patients receiving rocuronium or cisatracurium during anesthesia, analyzing age distribution (p=0.429), gender (p=0.839), ASA status (p=0.228), and physical characteristics (height, weight, BMI, p>0.05). Recovery parameters such as hand grip, sustained head lift, and double burst stimulation (DBS) twitch response showed no significant differences between groups (p=0.538 for hand grip and sustained head lift; p=0.220 for DBS. Late recovery rates at 15 minutes were observed with 16% for hand grip, 14% for sustained head lift, and 26% for DBS in the rocuronium group; compared to 14%, 10%, and 16%, respectively, in the cisatracurium group. Conclusion The study found significant postoperative residual curarization in both groups, emphasizing the need for intraoperative and PACU peripheral nerve stimulation for effective assessment. Further research on intraoperative variables could improve understanding of residual paralysis in PACU, guiding better anesthesia management.
背景 神经肌肉阻滞剂对麻醉至关重要，但可导致可逆性麻痹，从而引发如术后残留功能障碍等风险。麻醉后护理单元（PACU）中未被检测到的麻痹会损害气道功能并增加并发症，危及患者安全。通过临床评估或神经刺激进行有效的逆转对于预防术后残留箭毒化（RPOC）至关重要，RPOC与显著的发病率和死亡率相关。评估罗库溴铵和顺式阿曲库铵等药物有助于优化麻醉效果和患者恢复。方法 该研究纳入了100名经印度芒格洛尔卡斯图尔巴医学院机构审查委员会批准的美国麻醉医师协会（ASA）I级和II级患者。向患者介绍了该研究，获得了书面知情同意，并进行了麻醉前评估，包括讨论麻醉程序和相关风险。在获得同意后，指示他们禁食过夜。结果 该研究比较了100名在麻醉期间接受罗库溴铵或顺式阿曲库铵的ASA I级和II级患者，分析了年龄分布（p = 0.429）、性别（p = 0.839）、ASA分级（p = 0.228）和身体特征（身高、体重、BMI，p>0.05）。恢复参数如握力、持续抬头和双爆发刺激（DBS）抽搐反应在两组之间无显著差异（握力和持续抬头p = 0.538；DBS p = 0.220）。观察到罗库溴铵组在15分钟时的后期恢复率为：握力16%，持续抬头14%，DBS 26%；相比之下，顺式阿曲库铵组分别为14%、10%和16%。结论 该研究发现两组均存在显著的术后残留箭毒化，强调了在术中及PACU进行外周神经刺激以进行有效评估的必要性。对术中变量的进一步研究可以增进对PACU残留麻痹的理解，指导更好的麻醉管理。
