کد مقاله کد نشریه سال انتشار مقاله انگلیسی نسخه تمام متن
5884286 1567655 2016 7 صفحه PDF دانلود رایگان
عنوان انگلیسی مقاله ISI
Original ContributionCisatracurium- and rocuronium-associated residual neuromuscular dysfunction under intraoperative neuromuscular monitoring and postoperative neostigmine reversal: a single-blind randomized trial
موضوعات مرتبط
علوم پزشکی و سلامت پزشکی و دندانپزشکی بیهوشی و پزشکی درد
پیش نمایش صفحه اول مقاله
Original ContributionCisatracurium- and rocuronium-associated residual neuromuscular dysfunction under intraoperative neuromuscular monitoring and postoperative neostigmine reversal: a single-blind randomized trial
چکیده انگلیسی


- RNMB is a common complication of postoperative recovery.
- A considerably low (5.0%) incidence of RNMB 15 minutes after extubation was found.
- An increase in the cases of T4:T1 ratio <0.9 at 30 to 60 minutes after extubation was noticed.
- TOF monitoring in the awake patient showed to be tolerable.

BackgroundPostoperative residual neuromuscular blockade (RNMB) is a common complication in the postanesthesia care unit (PACU), but also one of the most controversial issues. Many studies and trials demonstrated that some methods and techniques can reduce the incidence and the extent of the phenomenon.Study ObjectiveTo determine the incidence of RNMB in the PACU at standardized times after extubation with the implementation of a protocol of careful neuromuscular blockade management.DesignRandomized, single-blinded controlled clinical trial.SettingOperating room and PACU.PatientsA total of 120 patients of either sex with American Society of Anesthesiologists grades 1, 2, and 3, aged 18 to 80 years were scheduled to undergo elective abdominal surgical procedures lasting for at least 60 minutes.InterventionsPatients were randomized to receive either cisatracurium (n = 60) or rocuronium (n = 60) at the time of intubation and during surgery. Every patient received quantitative neuromuscular monitoring during general anesthesia. On completion of surgery, patients were given neostigmine 0.05 mg kg−1. Patients were extubated at a train-of-four (TOF) ratio ≥0.9.MeasurementsTOF measurements were performed 15, 30, and 60 minutes after extubation. Tolerability of neuromuscular monitoring was evaluated with a scale from 1 to 10 (with 1 meaning no discomfort at all and 10 meaning maximal discomfort or pain).ResultsSix, 11, and 14 patients (5.0%, 9.2%, and 11.7%) exhibited a TOF ratio <0.9 at 15, 30, and 60 minutes after extubation, respectively. No statistically significant difference in the postoperative RNMB between cisatracurium and rocuronium was found. The median tolerability score for neuromuscular monitoring was 3.ConclusionCareful conduction, monitoring, and subsequent reversal of neuromuscular block may allow for obtaining considerably low incidence of residual neuromuscular block. However, our trial shows that some mid- and long-term cases of TOF ratios <0.9 can still occur, possibly jeopardizing the patients' postoperative recovery.

ناشر
Database: Elsevier - ScienceDirect (ساینس دایرکت)
Journal: Journal of Clinical Anesthesia - Volume 35, December 2016, Pages 198-204
نویسندگان
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