Dubois Philippe E, Moreillon Fabien, Bihin Benoit, De Dorlodot Clotilde, Meyer Sabrina, Maseri Adrien, Passeraub Philippe A, d'Hollander Alain A
Université catholique de Louvain, CHU UcL Namur, site Godinne, Yvoir, Belgium.
Anesthesiology Department, CHU UcL Namur, 1, Avenue G. Thérasse, Yvoir, 5530, Belgium.
J Clin Monit Comput. 2025 Apr 1. doi: 10.1007/s10877-025-01282-2.
Neuromuscular block recovery was evaluated using high-frequency tetanic ulnar nerve simulations compared to normalized train-of-four (NTOF) in anesthetized patients. Under intravenous general anesthesia, we compared rocuronium-induced neuromuscular recovery using 5 s 100- and 200-Hz tetanic stimulations via isometric mechanomyography to acceleromyographic NTOF in 20 consenting patients. The primary outcome was the comparison by Student's t-tests of 100- and 200-Hz tetanic fade ratios (residual force at the end of the contraction / maximal force reached during the 5 s) before rocuronium administration and at different recovery levels. The secondary outcome was the quantification of any significant fade occurring with 100- and 200-Hz stimulations after reaching the acceleromyographic NTOF ratio of 0.9 during subsequent stages of spontaneous recovery until their fade ratios exceeded 0.9. During early (TOF count ≥ 1) and intermediate (NTOF ratio ≥ 0.5) stages of recovery, both 100- and 200-Hz tetanic fade ratios were similarly low. However, during late recovery when NTOF ratio ≥ 0.9, 200-Hz stimulation induced a significantly deeper muscular fade than 100-Hz (tetanic fade ratio 0.20 ± 0.23 vs. 0.64 ± 0.29, P < 0.001). The delays between the recovery of NTOF ratio 0.9 and 100- or 200-Hz tetanic fade ratio 0.9 were 7.7 ± 7.1 and 43.6 ± 14.6 min, respectively. In anesthetized humans, mechanomyographic 200-Hz tetanic stimulation detects lighter levels of residual paralysis than NTOF and 100-Hz tetanic stimulation during a valuable additional period. Registered in the ClinicalTrials.gov Registry NCT05474638 on July 15th 2022.
在麻醉患者中，通过与标准化四个成串刺激（NTOF）对比，使用高频强直刺激尺神经来评估神经肌肉阻滞的恢复情况。在静脉全身麻醉下，我们通过等长机械肌电图，对20名同意参与的患者使用5秒100赫兹和200赫兹的强直刺激，与加速度肌电图NTOF对比，比较罗库溴铵诱导的神经肌肉恢复情况。主要结局是通过学生t检验比较罗库溴铵给药前及不同恢复水平时100赫兹和200赫兹强直衰减率（收缩末期残余力/5秒内达到的最大力）。次要结局是在自发恢复的后续阶段，当加速度肌电图NTOF比率达到0.9后，直至其衰减率超过0.9时，对100赫兹和200赫兹刺激出现的任何显著衰减进行量化。在恢复的早期（四个成串刺激计数≥1）和中期（NTOF比率≥0.5）阶段，100赫兹和200赫兹的强直衰减率同样较低。然而，在恢复后期当NTOF比率≥0.9时，200赫兹刺激诱导的肌肉衰减明显比100赫兹更深（强直衰减率0.20±0.23 vs. 0.64±0.29，P<0.001）。NTOF比率恢复到0.9与100赫兹或200赫兹强直衰减率恢复到0.9之间的延迟分别为7.7±7.1分钟和43.6±14.6分钟。在麻醉的人体中，在一个有价值的额外时间段内，机械肌电图200赫兹强直刺激比NTOF和100赫兹强直刺激能检测到更轻程度的残余麻痹。于2022年7月15日在ClinicalTrials.gov注册，注册号NCT05474638。
