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

IF 3.7 3区 医学 Q1 ANESTHESIOLOGY Anaesthesia Critical Care & Pain Medicine Pub Date : 2024-10-16 DOI:10.1016/j.accpm.2024.101445
Chang-Hoon Koo , Soowon Lee , Subin Yim , Yu Kyung Bae , Insun Park , Ah-Young Oh
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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, NCT 05760560.
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使用推荐剂量的舒格迈司后是否必须进行定量神经肌肉监测?一项前瞻性观察研究。
背景:一些麻醉师想知道,在使用舒马定拮抗神经肌肉阻滞(NMB)时,是否有必要确认四次肌力比(TOFR)≥0.9。在这项研究中,我们旨在确定在神经肌肉监测(NMM)下按推荐剂量使用舒甘美是否能确保完全康复,即使没有进一步的 NMM:这项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,给患者注射苏加麦司(四次运动(TOF)计数≥1为2毫克/千克,TOF计数=0且四次运动后计数≥1为4毫克/千克)。停用 NMM,随后的恢复由主治麻醉师决定。进入麻醉后护理病房 (PACU) 后立即测量两次 TOFR。主要结果是非正态化TOFR(nTOFR)的发生率:nTOFR 的发生率 结论:在定性 NMM 下使用推荐剂量的苏加麦司时,到达 PACU 时残留 NMB 的情况经常发生,这表明定量 NMM 是确保充分恢复的必要条件:注册:临床试验,NCT05760560。
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来源期刊
CiteScore
6.70
自引率
5.50%
发文量
150
审稿时长
18 days
期刊介绍: Anaesthesia, Critical Care & Pain Medicine (formerly Annales Françaises d''Anesthésie et de Réanimation) publishes in English the highest quality original material, both scientific and clinical, on all aspects of anaesthesia, critical care & pain medicine.
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