The Incidence of Postoperative Residual Curarization in the Recovery Room after Rocuronium Administration
Authors:
M. Adamus 1; J. Koutná 1; Č. Neoral 2
Authors place of work:
Klinika anesteziologie a resuscitace, Fakultní nemocnice a lékařská fakulta Univerzity Palackého, Olomouc, přednosta: MUDr. O. Marek
1; I. chirurgická klinika, Fakultní nemocnice a lékařská fakulta Univerzity Palackého, Olomouc, přednosta: doc. MUDr. Č. Neoral, CSc.
2
Published in the journal:
Rozhl. Chir., 2007, roč. 86, č. 1, s. 11-16.
Category:
Monothematic special - Original
Summary
In 513 patients, we investigated residual curarization after general anaesthesia with rocuronium administered, without peroperative neuromuscular blockade monitoring. On admission to the recovery room, the ulnar nerve was stimulated submaximally (30 mA) and the evoked muscle response was quantified with accelerometry (TOF-Watch® SX, Organon). The postoperative residual curarization was defined as a TOF-ratio < 0.9 and could be demonstrated in 174 patients (34 %). Compared to the group with adequate recovery, these patients received larger rocuronium dose [45.4 (SD 13.2) mg vs. 40.4 (SD 14.3) mg, p < 0.01], less experienced anaesthesiologists conducted their case [p < 0.01], shorter time had elapsed since the last rocuronium dose [58.4 (20.9) min. vs. 64.9 (27.2) min., p < 0.05], their core temperature was lower [35.4 (0.6) °C vs. 35.8 (0.6) °C, p < 0.01] and on average, they received less neostigmine during anaesthesia [0.26 (0.47) mg vs. 0.57 (0.71) mg, p < 0.01]. We conclude that it is necessary to antagonize residual block after rocuronium, especially in the absence of perioperative neuromuscular monitoring.
Key words:
post-operative residual curarization – neuromuscular blocker – rocuronium – recovery room
Zdroje
1. Viby-Mogensen, J. Postoperative residual curarization and evidence-based anaesthesia. British Journal of Anaesthesia, 2000, roč. 84, č. 3, s. 301–303.
2. Eriksson, L. I., Lennmarken, C., Wyon, N., Johnson, A. Attenuated ventilatory response to hypoxaemia at vecuronium-induced partial neuromuscular block. Acta Anaesthesiologica Scandinavica, 1992, roč. 36, č. 7, s. 710–715.
3. Eriksson, L. I., Sundman, E., Olsson, R. et al. Functional assessment of the pharynx at rest and during swallowing in partially paralyzed humans: simultaneous videomanometry and mechanomyography of awake human volunteers. Anesthesiology, 1997, roč. 87, č. 5, s. 1029–1031.
4. Adamus, M., Adamus, P., Bělohlávek, R., Vujčíková, M., Janásková, E. Vliv odlišných dávek rokuronia na jeho farmakodynamický profil: prospektivní studie. Anesteziologie a intenzivní medicína, 2004, roč. 15, č. 6, s. 269–275.
5. Cammu, G., De Baerdemaeker, L., Den Blauwen, N., De Mey, J. C., Struys, M., Mortier, E. Postoperative residual curarization with cisatracurium and rocuronium infusions. European Journal of Anaesthesiology, 2002, roč. 19, č. 2, s. 129–134.
6. References and formulas ušed by the Body Surface Area Calculator. Formula for Body Mass Index [on line] [citováno 12. července 2006] Dostupný z WWW <http://www.halls.md/body-surface-area/refs.htm>
7. Beemer, G. H., Rozental, P. Postoperative neuromuscular function. Anaesthesia and intensive care, 1986, roč. 14, č. 1, s. 41–45.
8. Cammu, G. Postoperative residual curarisation: complication or malpractice? Acta Anaesthesiologica Belgica, 2004, roč. 55, č. 3, s. 245–249.
9. Baillard, C., Clec, H. C., Catineau, J., Salhi, F., Gehan, G., Cupa, M., Samama, C. M. Postoperative residual neuromuscular block: a survey of management. British Journal of Anaesthesia, 2005, roč. 95, č. 5, s. 622–626.
10. Cammu, G., De Witte, J., De Veylder, J., Byttebier, G., van de Put, D., Foubert, L., van den Broucke, G., Deloof, T. Postoperative residual paralysis in outpatients versus inpatients. Anesthesia and Analgesia, 2006, roč. 102, č. 2, s. 426–429.
11. Murphy, G. S. Residual neuromuscular blockade: incidence, assessment, and relevance in the postoperative period. Minerva Anestesiologica, 2006, roč. 72, č. 3, s. 97–109.
12. Pafko, P. Chirurg jako vysokoškolský učitel a věda. Rozhledy v chirurgii, 2004, roč. 83, č. 12, s. 607–608.
13. Beecher, H. K., Todd, D. P. A study of the deaths associated with anesthesia and surgery: based on a study of 599, 548 anesthesias in ten institutions 1948–1952, inclusive. Annals of surgery, 1954, roč. 140, č. 1, s. 2–35.
14. Viby-Mogensen, J., Jorgensen, B. C., Ording, M. Residual curarization in the recovery room. Anesthesiology, 1979, roč. 50, č. 6, s. 539-541.
15. Andersen, B. N., Madsen, J. V., Schurizek, B. A., Juhl, B. Residual curarization: a comparative study of atracurium and pancuronium. Acta Anaesthesiologica Scandinavica, 1988, roč. 32, č. 2, s. 79–81.
16. Bevan, D. R., Smith, C. E., Donati, F. Postoperative neuromuscular blockade: a comparison between atracurium, vecuronium and pancuronium. Anestesiology, 1988, roč. 69, č. 2, s. 272–276.
17. Berg, H., Roed, J., Viby-Mogensen, J., Mortensen, C. R., Engbaek, J., Skovgaard, L. T., Krintel, J. J. Residual neuromuscular block is a risk factor for postoperative pulmonary complications. A prospective, randomised, and blinded study of postoperative pulmonary complications after atracurium, vecuronium and pancuronium. Acta Anaesthesiologica Scandinavica, 1997, roč. 41, č. 9, s. 1095–1103.
18. Baillard, C., Gehan, G., Reboul-Marty, J., Larmignat, P., Samama, C. M., Cupa, M. Residual curarization in the recovery room after vecuronium. British Journal of Anaesthesia, 2000, roč. 84, č. 3, s. 394–395.
19. McCaul, C., Tobin, E., Boylan, J. F., McShane, A. J. Atracurium is associated with postoperative residual curarization. British Journal of Anaesthesia, 2002, roč. 89, č. 5, s. 766–769.
20. Kopman, A. F., Yee, P. S., Neuman, G. G. Relationship of the train-of-four fade ratio to clinical signs and symptoms of residual paralysis in awake volunteers. Anesthesiology, 1997, roč. 86, č. 4, s. 765–771.
21. Bevan D. Reversal of neuromuscular block: the case FOR reversal. Acta Anaesthesiologica Scandinavica Suppl, 1997, roč. 41, č. 110, s. 102.
22. Mortensen, C. R., Berg, H., El-Mahdy, A., Viby-Mogensen, J. Perioperative monitoring of neuromuscular transmission using acceleromyography prevents residual neuromuscular block following pancuronium. Acta Anaesthesiologica Scandinavica, 1995, roč. 39, č. 6, s. 797–801.
23. Cheng, C. R., Sessler, D. I., Apfel, C. C. Does neostigmine administration produce a clinically important increase in postoperative nausea and vomiting? Anesthesia and analgesia, 2005, roč. 101, č. 5, s. 1349–1355.
24. Osmer, C., Vogele, C., Zickmann, B., Hempelmann, G. Comparative use of muscle relaxants and their reversal in three European countries: a survey in France, Germany and Great Britain. European Journal of Anaesthesiology, 1996, roč. 13, č. 4, s. 389–399.
25. Adamus, M., Marek, O. Monitorování účinku kurarimimetik během anestezie - současný stav v České republice. Anesteziologie a neodkladná péče, 2000, roč. 11, č. 6, s. 245–250.
26. Heier, T., Caldwell, J. E. Impact of hypothermia on the response to neuromuscular blocking drugs. Anesthesiology, 2006, roč. 104, č. 5, s. 1070–1080.
27. Sorgenfrei, I. F., Viby-Mogensen, J., Swiatek, F. A. Does evidence lead to a change in clinical practice? Danish anaesthetists‘ and nurse anesthetists‘ clinical practice and knowledge of postoperative residual curarization. Ugeskrift for laeger, 2005, roč. 167, č. 41, s. 3878–3882.
Štítky
Surgery Orthopaedics Trauma surgeryČlánok vyšiel v časopise
Perspectives in Surgery
2007 Číslo 1
- Metamizole at a Glance and in Practice – Effective Non-Opioid Analgesic for All Ages
- Metamizole vs. Tramadol in Postoperative Analgesia
- Spasmolytic Effect of Metamizole
Najčítanejšie v tomto čísle
- Liver Hemangiomas – Diagnostic and Treatment Strategy
- Undiagnosed Posterior Dislocations of the Shoulder Joint. A Preliminary Report
- Multiple Diverticulosis of the Small and Large Intestine. A Case Review
- Insufficient Anastomoses in Sigmoideal and Rectal Resections. A Retrospective Study Conducted in a Surgical Clinic in Hradec Králové