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Respiratory muscle activity after spontaneous, neostigmine- or sugammadex-enhanced recovery of neuromuscular blockade : a double blind prospective randomized controlled trial

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العنوان: Respiratory muscle activity after spontaneous, neostigmine- or sugammadex-enhanced recovery of neuromuscular blockade : a double blind prospective randomized controlled trial
المؤلفون: Sabine Maes, Philippe G. Jorens, Koen Janssens, Davina Wildemeersch, Jurryt Vellinga, Tom Schepens, Vera Saldien
المصدر: BMC anesthesiology
BMC Anesthesiology
BMC Anesthesiology, Vol 19, Iss 1, Pp 1-7 (2019)
سنة النشر: 2019
مصطلحات موضوعية: Adult, Male, Time Factors, Neuromuscular transmission, Remifentanil, Diaphragmatic breathing, Sugammadex, lcsh:RD78.3-87.3, 03 medical and health sciences, 0302 clinical medicine, Double-Blind Method, 030202 anesthesiology, medicine, Respiratory muscle, Humans, 030212 general & internal medicine, Prospective Studies, Respiratory outcome, Propofol, Aged, Neuromuscular Blockade, business.industry, Electromyography, Middle Aged, Neostigmine, Respiratory Muscles, Anesthesiology and Pain Medicine, Neuromuscular blocking agents, lcsh:Anesthesiology, Anesthesia, Female, Human medicine, business, medicine.drug, Research Article
الوصف: Background The use of neostigmine after neuromuscular blockade (NMB) has been associated with postoperative respiratory complications. In previous studies, we found lower diaphragmatic activity after neostigmine reversal of NMB, compared to sugammadex. It is still unclear whether the adequate use of neostigmine guarantees normal respiratory muscle function after NMB. In this study, we wanted to assess the effect of commonly used degrees of NMB and their possible reversal strategies on respiratory muscle activity after the return of normal neuromuscular transmission. Methods This is a randomized, controlled, parallel-group, single-centre, double-blind study in patients scheduled for intracranial surgery at a tertiary academic hospital in Belgium. All participants received target controlled propofol/remifentanil anesthesia and were randomized into one of five groups, receiving either a shallow NMB with no reversal (shallow/saline), a shallow NMB with sugammadex reversal (shallow/sugammadex), a moderate NMB with neostigmine reversal (moderate/neostigmine), a moderate NMB with sugammadex reversal (moderate/sugammadex), or a deep NMB with sugammadex reversal (deep/sugammadex). Primary and secondary outcome parameters were diaphragm and intercostal electromyographic (EMG) activity at the moment of resumed spontaneous breathing activity, defined as a maximal interval of 10 min after the first spontaneous breath. Results For the five groups, a total of 55 patients could be included in the final analysis. Median time of spontaneous breathing analyzed was 5 min (IQR 3–9.5 min). Both the moderate/sugammadex and the moderate/neostigmine groups had lower levels of diaphragm EMG compared to the shallow/sugammadex group. The moderate/neostigmine group had lower levels of intercostal EMG activity compared to the shallow/saline group. Conclusions In this study, the depth of neuromuscular blockade and type of reversal strategy impacts respiratory muscle activity at the moment of resumed spontaneous breathing and recovery of neuromuscular blockade. Both groups that received moderate NMB had lower levels of diaphragm EMG, compared to the shallow NMB group with sugammadex reversal. Compared to the shallow NMB group with no reversal, the moderate NMB with neostigmine reversal group had lower intercostal EMG activity. Trial registration Clinicaltrials.gov NCT01962298 on October 9, 2013 and EudraCT 2013–001926-25 on October 10, 2013.
وصف الملف: pdf
اللغة: English
تدمد: 1471-2253
URL الوصول: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::49ad2187b60d6c527e37198edd872e28
https://repository.uantwerpen.be/docman/irua/74791f/163713.pdf
حقوق: OPEN
رقم الأكسشن: edsair.doi.dedup.....49ad2187b60d6c527e37198edd872e28
قاعدة البيانات: OpenAIRE
الوصف
تدمد:14712253