正反辩论:在糖糖时代,我们需要定量神经肌肉监测吗?

M. Blobner, M. Hollmann, M. Luedi, Ken Johnson
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引用次数: 7

摘要

在这篇文章中,我们讨论了使用定量神经肌肉阻断监测的优点。共识指南推荐使用它们来指导非去极化神经肌肉阻断剂和逆转剂的给药。该指南的一个主要障碍是,直到最近,可靠的定量神经肌肉阻断监测仪还没有广泛使用。没有它们,麻醉提供者已经接受过训练,并熟练使用各种定性神经肌肉阻断监测器,或称为周围神经刺激器。虽然可能不太准确,但麻醉提供者发现它们可靠且易于使用。他们有使用它们的长期记录,认为它们的使用导致有效的神经肌肉阻断逆转,并最大限度地减少残留神经肌肉阻断的临床显著不良事件。在最近的过去,2个破坏性的发展要求麻醉护理人员重新考虑他们在神经肌肉阻断给药、逆转和监测方面的做法。这包括:(1)更可靠的定量神经肌肉监测器的商业化;(2)广泛使用sugammadex,一种多功能神经肌肉阻断逆转剂。Sugammadex似乎在快速有效地逆转最深的神经肌肉阻塞方面如此有效,这让麻醉提供者怀疑定量监测是否确实必要,还是传统的、熟悉的、更便宜的定性监测就足够了?这场支持与反对的辩论将对比麻醉提供者对定量神经肌肉阻断监测仪使用的看法和证据,以探讨定量神经肌肉监测(NMM)是否只是寻找问题的另一种技术解决方案,还是NMM的重大进步,将提高患者的安全性和预后。
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Pro-Con Debate: Do We Need Quantitative Neuromuscular Monitoring in the Era of Sugammadex?
In this Pro-Con article, we debate the merits of using quantitative neuromuscular blockade monitoring. Consensus guidelines recommend their use to guide the administration of nondepolarizing neuromuscular blockade and reversal agents. A major impediment to this guideline is that until recently, reliable quantitative neuromuscular blockade monitors have not been widely available. Without them, anesthesia providers have been trained with and are adept at using a variety of qualitative neuromuscular blockade monitors otherwise known as peripheral nerve stimulators. Although perhaps less accurate, anesthesia providers find them reliable and easy to use. They have a long track record of using them with the perception that their use leads to effective neuromuscular blockade reversal and minimizes clinically significant adverse events from residual neuromuscular blockade. In the recent past, 2 disruptive developments have called upon anesthesia care providers to reconsider their practice in neuromuscular blockade administration, reversal, and monitoring. These include: (1) commercialization of more reliable quantitative neuromuscular monitors and (2) widespread use of sugammadex, a versatile reversal agent of neuromuscular blockade. Sugammadex appears to be so effective at rapidly and effectively reversing even the deepest of neuromuscular blockades, and it has left anesthesia providers wondering whether quantitative monitoring is indeed necessary or whether conventional, familiar, and less expensive qualitative monitoring will suffice? This Pro-Con debate will contrast anesthesia provider perceptions with evidence surrounding the use of quantitative neuromuscular blockade monitors to explore whether quantitative neuromuscular monitoring (NMM) is just another technology solution looking for a problem or a significant advance in NMM that will improve patient safety and outcomes.
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