scholarly journals Quantitative Relationships between Pulmonary Function and Residual Neuromuscular Blockade

2018 ◽  
Vol 2018 ◽  
pp. 1-6
Author(s):  
ShuYing Fu ◽  
WenDong Lin ◽  
XiNing Zhao ◽  
ShengJin Ge ◽  
ZhangGang Xue
Keyword(s):  
Pulmonary Function ◽  
Neuromuscular Blockade ◽  
Demographic Data ◽  
Preoperative Evaluation ◽  
Tracheal Extubation ◽  
Postanesthesia Care Unit ◽  
Predictive Values ◽  
Residual Neuromuscular Blockade ◽  
Significant Difference ◽  
Train Of Four

Background. Neuromuscular blockade is a risk factor for postoperative respiratory weakness during the immediate postoperative period. The quantitative relationships between postoperative pulmonary-function impairment and residual neuromuscular blockade are unknown. Methods. 113 patients who underwent elective laparoscopic cholecystectomy were enrolled in this study. They all had a pulmonary-function test (PFT) during the preoperative evaluation. Predictive values based on demographic data were also recorded. The train-of-four ratio (TOFR) was recorded at the same time as the PFT and at every 5 minutes in the qualified 98 patients in the postanesthesia care unit (PACU). We analyzed the degree of PFT recovery when the TOFR had recovered to different degrees. Results. There was a significant difference (P<0.05) between the preoperative baseline value and the postoperative forced vital capacity at each TOFR point, except at a TOFR value of 1.1. There was also a significant difference (P<0.05) between the preoperative baseline value and the postoperative peak expiratory flow at each TOFR point. Conclusions. Postoperative residual neuromuscular blockade was common (75.51%) after tracheal extubation, and pulmonary function could not recover to an acceptable level (85% of baseline value), even if TOFR had recovered to 0.90. Trial Registration. Chinese Clinical Trial Register is ChiCTR-OOC-15005838.

Intraoperative Acceleromyographic Monitoring Reduces the Risk of Residual Meeting Abstracts and Adverse Respiratory Events in the Postanesthesia Care Unit

2008 ◽  
Vol 109 (3) ◽  
pp. 389-398 ◽  
Author(s):  
Glenn S. Murphy ◽  
Joseph W. Szokol ◽  
Jesse H. Marymont ◽  
Steven B. Greenberg ◽  
Michael J. Avram ◽  
...  
Keyword(s):  
Neuromuscular Blockade ◽  
Anesthetic Management ◽  
Arterial Oxygen Saturation ◽  
Arterial Oxygen ◽  
Postanesthesia Care Unit ◽  
Early Recovery ◽  
Residual Neuromuscular Blockade ◽  
Respiratory Events ◽  
Train Of Four ◽  
Adverse Respiratory Events

Background Incomplete recovery from neuromuscular blockade in the postanesthesia care unit (PACU) may contribute to adverse postoperative respiratory events. This study determined the incidence and degree of residual neuromuscular blockade in patients randomized to conventional qualitative train-of-four (TOF) monitoring or quantitative acceleromyographic monitoring. The incidence of adverse respiratory events in the PACU was also evaluated. Methods One hundred eighty-five patients were randomized to intraoperative acceleromyographic monitoring (acceleromyography group) or qualitative TOF monitoring (TOF group). Anesthetic management was standardized. TOF patients were extubated when standard criteria were met and no fade was observed during TOF stimulation. Acceleromyography patients had a TOF ratio of greater than 0.80 as an additional extubation criterion. Upon arrival in the PACU, TOF ratios of both groups were measured with acceleromyography. Adverse respiratory events during transport to the PACU and during the first 30 min of PACU admission were also recorded. Results A lower frequency of residual neuromuscular blockade in the PACU (TOF ratio &lt; or = 0.9) was observed in the acceleromyography group (4.5%) compared with the conventional TOF group (30.0%; P &lt; 0.0001). During transport to the PACU, fewer acceleromyography patients developed arterial oxygen saturation values, measured by pulse oximetry, of less than 90% (0%) or airway obstruction (0%) compared with TOF patients (21.1% and 11.1%, respectively; P &lt; 0.002). The incidence, severity, and duration of hypoxemic events during the first 30 min of PACU admission were less in the acceleromyography group (all P &lt; 0.0001). Conclusions Incomplete neuromuscular recovery can be minimized with acceleromyographic monitoring. The risk of adverse respiratory events during early recovery from anesthesia can be reduced by intraoperative acceleromyography use.

Residual Neuromuscular Block in HIV-Infected Young Patients: A Prospective Observational Study

2021 ◽  
Author(s):  
Ruixue hou ◽  
Liangyu wu ◽  
Yadong liu ◽  
Fangfang miao ◽  
Cheng yin ◽  
...  
Keyword(s):  
Reaction Time ◽  
Neuromuscular Block ◽  
Young Patients ◽  
Onset Time ◽  
Pulmonary Complications ◽  
Infected Group ◽  
Normal Group ◽  
Postanesthesia Care Unit ◽  
Residual Neuromuscular Blockade ◽  
Train Of Four

Abstract Objectives: Avoidance of residual neuromuscular blockade (RNMB) is crucial to decrease anesthesia-related pulmonary complications. At present, no data are available for HIV-infected patients about the occurrence of RNMB. In this trial, we aim to investigate the incidence of RNMB in such patients. Methods: Data were prospectively collected on 45 normal and 45 HIV-infected patients (18-65 yr). The train-of-four stimulation (TOF-Watch SX) was used to evaluate the level of neuromuscular block from the induction of anesthesia to back to the postanesthesia care unit (PACU) by an assessor, but blind to the anesthesiologist. Primary endpoint was the presence of RNMB at PACU admission, defined as a train-of-four (TOF) ratio < 0.9. The onset time (from application of cisatracurium to maximum depression of T1), no reaction time (from zero of T1 to non-zero), and clinical duration (from application to 25% recovery of T1) were determined for each patient. Results: The incidence of RNMB was 37.5% in HIV- infected patients and 32.5% in normal patients (difference, 5%; 99% CI, −16% to 26 1%; p=0.815). The onset time was no different between two groups (4.05±0.88 min in HIV-infected group vs. 3.85±1.08 min in normal group (p=0.37)). The no reaction time was also similarly between two groups ( 49.83±3.81min in HIV-infected group vs. 48.98±5.12min in normal group (p=0.40)). The clinical duration was 53.78±3.05 min and 52.40±5.02 min in HIV-infected group and normal group, respectively (p=0.14). Conclusion: The odds of RNMB were not significantly different in HIV-infected young patients compared to normal persons.

Comparison of the TOFscan and the TOF-Watch SX during Recovery of Neuromuscular Function

2018 ◽  
Vol 129 (5) ◽  
pp. 880-888 ◽  
Author(s):  
Glenn S. Murphy ◽  
Joseph W. Szokol ◽  
Michael J. Avram ◽  
Steven B. Greenberg ◽  
Torin D. Shear ◽  
...  
Keyword(s):  
Neuromuscular Blockade ◽  
Spontaneous Recovery ◽  
Three Dimensional ◽  
Tracheal Extubation ◽  
Neuromuscular Function ◽  
Neuromuscular Monitoring ◽  
Limits Of Agreement ◽  
Train Of Four ◽  
Good Agreement

Abstract Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New Background Quantitative neuromuscular monitoring is required to ensure neuromuscular function has recovered completely at the time of tracheal extubation. The TOFscan (Drager Technologies, Canada) is a new three-dimensional acceleromyography device that measures movement of the thumb in multiple planes. The aim of this observational investigation was to assess the agreement between nonnormalized and normalized train-of-four values obtained with the TOF-Watch SX (Organon, Ireland) and those obtained with the TOFscan during recovery from neuromuscular blockade. Methods Twenty-five patients were administered rocuronium, and spontaneous recovery of neuromuscular blockade was allowed to occur. The TOFscan and TOF-Watch SX devices were applied to opposite arms. A preload was applied to the TOF-Watch SX, and calibration was performed before rocuronium administration. Both devices were activated, and train-of-four values were obtained every 15 s. Modified Bland–Altman analyses were conducted to compare train-of-four ratios measured with the TOFscan to those measured with the TOF-Watch SX (when train-of-four thresholds of 0.2 to 1.0 were achieved). Results Bias and 95% limits of agreement between the TOF-Watch SX and the TOFscan at nonnormalized train-of-four ratios between 0.2 and 1.0 were 0.021 and −0.100 to 0.141, respectively. When train-of-four measures with the TOF-Watch SX were normalized, bias and 95% limits of agreement between the TOF-Watch SX and the TOFscan at ratios between 0.2 and 1.0 were 0.015 and −0.097 to 0.126, respectively. Conclusions Good agreement between the TOF-Watch SX with calibration and preload application and the uncalibrated TOFscan was observed throughout all stages of neuromuscular recovery.

scholarly journals Effect of Nutritional Status on Vecuronium Induced Neuromuscular Blockade

1998 ◽  
Vol 26 (4) ◽  
pp. 392-395 ◽  
Author(s):  
S. Sinha ◽  
A. K. Jain ◽  
A. Bhattacharya
Keyword(s):  
Nutritional Status ◽  
Neuromuscular Blockade ◽  
Marked Effect ◽  
Elective Surgery ◽  
Severe Malnutrition ◽  
Onset Of Action ◽  
Duration Of Action ◽  
Significant Difference ◽  
Train Of Four ◽  
Time To Onset

Based on simple clinical and biochemical parameters of nutritional status, seventy adult patients scheduled for elective surgery under general anaesthesia were categorized as having normal nutrition, mild, moderate or severe malnutrition or obesity Under anaesthesia, evoked responses on train-of-four nerve stimulation were recorded every 15 seconds on a mechanomyograph. Vecuronium 0.1 mg.kg-1 was used to achieve neuromuscular blockade. Compared with patients having normal nutrition, the time to onset of action was significant& prolonged in the moderate and severely malnourished groups; the time to no response on train-of-four stimulation was delayed only in severely malnourished groups (P<0.001). The duration of action of the initial dose was shorter in the moderate and severely malnourished groups. The obese group had an earlier onset of action and a longer duration of action compared with patients of normal nutrition (P<0.001). No significant difference in recovery time to a train-of-four ratio of 0.70 was observed between the malnourished and patients with normal nutrition. Malnutrition hus a marked effect on vecuronium-induced neuromuscular blockade.

Residual Neuromuscular Blockade and Critical Respiratory Events in the Postanesthesia Care Unit

2008 ◽  
Vol 107 (1) ◽  
pp. 130-137 ◽  
Author(s):  
Glenn S. Murphy ◽  
Joseph W. Szokol ◽  
Jesse H. Marymont ◽  
Steven B. Greenberg ◽  
Michael J. Avram ◽  
...  
Keyword(s):  
Neuromuscular Blockade ◽  
Postanesthesia Care Unit ◽  
Residual Neuromuscular Blockade ◽  
Respiratory Events

scholarly journals Usefulness of intra-operative neuromuscular blockade monitoring and reversal agents for postoperative residual neuromuscular blockade: a retrospective observational study

2019 ◽  
Author(s):  
Gonzalo Domenech ◽  
Matias Kampel ◽  
Maria Eugenia Garcia Guzzo ◽  
Delfina Sanchez Novas ◽  
Sergio Terrasa ◽  
...  
Keyword(s):  
Neuromuscular Blockade ◽  
Multivariable Analysis ◽  
Perioperative Period ◽  
University Hospital ◽  
Exclusion Criterion ◽  
Adductor Pollicis Muscle ◽  
Residual Neuromuscular Blockade ◽  
Reversal Agents ◽  
Elective Surgical Procedures ◽  
Train Of Four

Abstract Background: Current neuromuscular blockade (NMB) management techniques cannot completely prevent residual NMB (RNMB) during the postoperative period. Evidently, compliance to NMB monitoring is persistently low, and the risk of RNMB during the perioperative period remains underestimated. We have not found publications that report the incidence of RNMB in a university hospital where access to quantitative NMB monitoring and sugammadex is unlimited and where NMB management is not protocolised. The primary aim of this study was to estimate the incidence of RNMB in patients managed with or without sugammadex or neostigmine as antagonists and quantitative NMB monitoring in the operating room. The secondary aim was to explore the associations between RNMB and potentially related variables. Methods: This retrospective observational cohort study was conducted at a tertiary referral university hospital in Buenos Aires, Argentina. Records created between June 2015 and December 2015 were reviewed. In total, 240 consecutive patients who had undergone elective surgical procedures requiring NMB were included. All patients were monitored via acceleromyography at the adductor pollicis muscle within 5 min of arrival in the postanaesthesia care unit. Scheduled recovery in the intensive care unit was the only exclusion criterion. The primary outcome was the presence of RNMB, defined as a train-of-four ratio of <0.9. The secondary outcomes were the associations between RNMB and potentially related variables. Results: RNMB was present in 1.6% patients who received intra-operative quantitative NMB monitoring and 32% patients whose NMB was not monitored (P<0.01). Multivariable analysis revealed that the use of intra-operative quantitative NMB monitoring and sugammadex were associated with a lower incidence of RNMB, with calculated odds ratios of 0.04 (95% confidence interval [CI]: 0.005 to 0.401) and 0.18 (95% CI: 0.046 to 0.727), respectively. Conclusions: The results of the present study suggest that quantitative intra-operative NMB monitoring and use of sugammadex are associated with a decreased incidence of RNMB in the PACU, reinforcing the contention that the optimal strategy for RNMB avoidance is the use of quantitative NMB monitoring and eventual use of reversal agents, if needed, prior to emergence from anaesthesia.

scholarly journals Evaluating the effect of calcium chloride in combination with neostagmine and atropine against residual neuromuscular blockade at the end of general anesthesia

QJM ◽  
2020 ◽  
Vol 113 (Supplement_1) ◽  
Author(s):  
M M Marzouk ◽  
R A Shoukry ◽  
S A Refaat ◽  
A M Fathi
Keyword(s):  
General Anesthesia ◽  
Endotracheal Tube ◽  
Calcium Chloride ◽  
Neuromuscular Blockade ◽  
P Value ◽  
Double Blind ◽  
Residual Neuromuscular Blockade ◽  
Significant Difference ◽  
Group A ◽  
Group B

Abstract Background Muscle relaxants used in general anesthesia during the insertion of an endotracheal tube (ETT) to relax the muscles of the neck and throat, which reduces the risk of injury. They also are used to relax the chest muscles when an endotracheal tube is used to aid mechanical ventilation. Objective The aim of this study has been to evaluate the effect of calcium chloride coadministered with neostigmine and atropine on neuromuscular blockade recovery time at the end of general anesthesia. And compare it’s effect against usual neuromuscular reverse of neostigmine and atropine. Patients and Methods In this present study we use Double blind prospective randomized Clinical trial study, 30 patients were enrolled. They were divided in two groups each of which contains 15 patients: Group (A): received 5 mg/kg of calcium chloride coadministered with 25 μg/kg of neostigmine and 15 μg/kg of atropine at the end of surgery. Group (B): received the same volume of normal saline coadministered with 25 μg kg of neostigmine and 15 μg / kg of atropine at the end of surgery. Results Comparison between calcium and neostigmine groups according TOF at 5 minutes and 10 minutes using Independent t-test, P- value was less than 0.01 which means that there is high significant difference between 2 groups. On the other hand, TOF at 20 minutes in calcium and neostigmine groups shows no difference at all. Conclusion So Calcium chloride elevate serum calcium level, calcium has antineuromuscular blockade effect, therefore calcium chloride increase TOF and enhance neuromuscular recovery and decrease the PORC after neostigmine administration.

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