在推荐剂量的 sugammadex 给药后是否必须进行定量神经肌肉监测？一项前瞻性观察研究。

Is quantitative neuromuscular monitoring mandatory after administration of the recommended dose of sugammadex? A prospective observational study.

机构信息

Department of Anaesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea; Department of Anaesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul, South Korea.

Department of Anaesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea.

出版信息

Anaesth Crit Care Pain Med. 2024 Dec;43(6):101445. doi: 10.1016/j.accpm.2024.101445. Epub 2024 Oct 16.

DOI:10.1016/j.accpm.2024.101445

PMID:39419348

Abstract

BACKGROUND

Some anaesthetists wonder whether confirming a train-of-four ratio (TOFR) ≥0.9 is necessary when using sugammadex to antagonise neuromuscular blockade (NMB). In this study, we aimed to determine whether using sugammadex at the recommended dose under neuromuscular monitoring (NMM) would ensure complete recovery, even without further NMM.

METHODS

This prospective observational study included 51 patients who underwent robot-assisted surgery under general anaesthesia between March and May 2023. At the end of surgery, sugammadex was administered (2 mg/kg for a train-of-four (TOF) count ≥1 and 4 mg/kg for a TOF count = 0 and a post-tetanic count ≥1). NMM was discontinued, and subsequent recovery was completed at the discretion of the attending anaesthetist. TOFR was measured twice immediately upon admission to the post-anaesthesia care unit (PACU). The primary outcome was the incidence of a non-normalised TOFR (nTOFR) <0.9 upon arrival in PACU. The secondary outcomes were the incidences of a nTOFR <0.7 or 1.0, symptoms/signs of residual NMB (diplopia, dyspnoea, and desaturation) and recovery profiles in PACU.

RESULTS

The incidence of a nTOFR <0.9 upon arrival in PACU was 5.9% (3/51 patients). No patient had a nTOFR <0.7, and 47.1% (24 patients) had a nTOFR <1.0, but no patients showed clinical symptoms/signs of residual NMB.

CONCLUSIONS

When the recommended dose of sugammadex was administered under qualitative NMM, residual NMB at the time of PACU arrival occurred frequently, indicating that quantitative NMM is necessary to ensure adequate recovery.

REGISTRATION

ClinicalTrials, NCT05760560.

摘要

背景

一些麻醉师怀疑在使用琥珀酰明胶拮抗神经肌肉阻滞（NMB）时，是否需要确认四成肌颤搐比（TOFR）≥0.9。在这项研究中，我们旨在确定在神经肌肉监测（NMM）下使用推荐剂量的琥珀酰明胶是否即使没有进一步的 NMM 也能确保完全恢复。

方法

本前瞻性观察研究纳入了 2023 年 3 月至 5 月期间在全身麻醉下接受机器人辅助手术的 51 名患者。手术结束时，给予琥珀酰明胶（TOF 计数≥1 时给予 2mg/kg，TOF 计数=0 且强直后计数≥1 时给予 4mg/kg）。停止 NMM，并由主治麻醉师决定随后的恢复情况。TOFR 在入住麻醉后恢复室（PACU）时立即测量两次。主要结局是 PACU 到达时出现非正常 TOFR（nTOFR）<0.9 的发生率。次要结局是 nTOFR<0.7 或 1.0 的发生率、残留 NMB 的症状/体征（复视、呼吸困难和饱和度降低）以及 PACU 中的恢复情况。