دورية أكاديمية
Management of rocuronium neuromuscular block using a protocol for qualitative monitoring and reversal with neostigmine.
| العنوان: | Management of rocuronium neuromuscular block using a protocol for qualitative monitoring and reversal with neostigmine. |
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| المؤلفون: | Thilen SR; Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, USA. Electronic address: sthilen@uw.edu., Ng IC; Department of Anesthesiology, Critical Care and Pain Medicine, St Elizabeth's Medical Center, Brighton, MA, USA., Cain KC; Department of Biostatistics, University of Washington School of Public Health, Seattle, WA, USA., Treggiari MM; Department of Anesthesiology and Perioperative Medicine, Oregon Health & Science University, Portland, OR, USA., Bhananker SM; Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, USA. |
| المصدر: | British journal of anaesthesia [Br J Anaesth] 2018 Aug; Vol. 121 (2), pp. 367-377. Date of Electronic Publication: 2018 May 19. |
| نوع المنشور: | Journal Article; Observational Study |
| اللغة: | English |
| بيانات الدورية: | Publisher: Elsevier Country of Publication: England NLM ID: 0372541 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1471-6771 (Electronic) Linking ISSN: 00070912 NLM ISO Abbreviation: Br J Anaesth Subsets: MEDLINE |
| أسماء مطبوعة: | Publication: 2018- : [London] : Elsevier Original Publication: London, Eng. [etc.] |
| مواضيع طبية MeSH: | Neostigmine* , Neuromuscular Nondepolarizing Agents*/adverse effects , Parasympathomimetics* , Rocuronium*/adverse effects, Monitoring, Physiologic/*methods , Neuromuscular Blockade/*methods, Adult ; Aged ; Airway Extubation/methods ; Clinical Protocols ; Cohort Studies ; Female ; Humans ; Incidence ; Male ; Middle Aged ; Muscle Weakness/chemically induced ; Muscle Weakness/epidemiology ; Postoperative Complications/epidemiology ; Prospective Studies |
| مستخلص: | Background: Neuromuscular block using subjective monitoring and neostigmine reversal is commonly associated with postoperative residual neuromuscular block. We tested whether a protocol for the management of neuromuscular block that specified appropriate dosing and optimal neostigmine reversal was associated with a reduction in postoperative residual neuromuscular block. Methods: Rocuronium administration was guided by surgical requirements and based on the ideal body weight, with dose reductions for female sex and age >55 yr. Neostigmine was administered in adjusted doses after a train-of-four count of four was confirmed at the thumb. The protocol ensured a minimum of 10 min between neostigmine administration and tracheal extubation. We measured the postoperative residual neuromuscular block in patients undergoing abdominal surgery before and after introduction of the protocol. Pre-specified primary and secondary endpoints were incidence of postoperative residual neuromuscular block and severe postoperative residual neuromuscular block at the time of tracheal extubation, defined as normalised train-of-four ratios <0.9 and <0.7, respectively. Results: The incidence of postoperative residual neuromuscular block at tracheal extubation was 14/40 (35%) for patients managed according to the protocol compared with 22/38 (58%) for patients in the control group, odds ratio of 0.39, and 95% confidence interval of 0.14-1.07; P=0.068. The incidence of severe postoperative residual neuromuscular block at tracheal extubation showed a highly significant difference, odds ratio=0.06, and confidence interval of 0.00-0.43; P=0.001. Conclusions: The incidence of severe postoperative residual neuromuscular block was significantly reduced after the protocol was introduced. Given the limitations inherent in this before-and-after study, further research is needed to confirm these results. Clinical Trial Registration: NCT02660398. (Copyright © 2018 British Journal of Anaesthesia. Published by Elsevier Ltd. All rights reserved.) |
| التعليقات: | Comment in: Br J Anaesth. 2018 Aug;121(2):335-337. (PMID: 30032868) |
| فهرسة مساهمة: | Keywords: muscle weakness/chemically induced; neostigmine; neuromuscular blocking agents; rocuronium |
| سلسلة جزيئية: | ClinicalTrials.gov NCT02660398 |
| المشرفين على المادة: | 0 (Neuromuscular Nondepolarizing Agents) 0 (Parasympathomimetics) 3982TWQ96G (Neostigmine) WRE554RFEZ (Rocuronium) |
| تواريخ الأحداث: | Date Created: 20180724 Date Completed: 20190102 Latest Revision: 20190102 |
| رمز التحديث: | 20240628 |
| DOI: | 10.1016/j.bja.2018.03.029 |
| PMID: | 30032875 |
| قاعدة البيانات: | MEDLINE |
| تدمد: | 1471-6771 |
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| DOI: | 10.1016/j.bja.2018.03.029 |