| BACKGROUNDAmong critical events in the immediate postoperative period, ventilatory depression, airway obstruction, and aspiration of gastric contents are the three most common life-threatening anesthesia-related complications. They account for more than two thirds of all critical events after an anesthetic procedure, and in most of these events the consequence for the patient is a risk of hypoxic injury. Residual effects of anesthetics play essential roles as underlying mechanisms of postoperative ventilatory failure and hypoxia. Impaired respiratory control may be caused by depression of central ventilatory control, by depression of peripheral sensory organs, such as the carotid body chemoreceptors, or by impaired control of the pharynx and the upper airways due to muscular weakness and dyscoordination with risk for airway obstruction and aspiration.Neuromuscular blocking drugs (NMBDs) are frequently administered to patients undergoing laparoscopic cholecystectomy (LC) surgical procedures under general anesthesia. Residualneuromuscular block, defined as a train-of-four (TOF) ratio <0.7, is observed in up to 20%-50% of patients who receive intraoperative pancuronium. In contrast, only 13.6% of patients administered intermediate-acting drugs demonstrate TOF ratios <0.7 in the PACU .However, the effect of choice of NMBD on PACU length of stay (LOS) has not previously been examined in a prospective, randomized clinical trial. An association between NMBDs use in the operating room (OR) and impaired clinical recovery in the PACU(hypoxia) has not been clearly established. In addition, a new "gold standard" for complete neuromuscular recovery should be established.OBJECTIVEExamined the effect of choice of neuromuscular blocking drugs(NMBDs) (pancuronium versus rocuronium) on postoperative recovery times and associated adverse outcomes. Establishe a new "gold standard" for complete neuromuscular recovery .MATERIALS AND METHODSPatients were randomly allocated to receive either rocuronium or pancuronium according to a computer-generated randomization code. Propofol 2 mg/kg, fentanyl 2-4ug/kg, and lidocaine 1.5mg/kg were administered to induce anesthesia. Patients received either pancuronium 0.08-0.10 mg/kg or rocuronium 0.6-1.0 mg/kg according to random allocation. Additional dosing of NMBDs was determined on the basis of neuromuscular monitoring. Boluses of either pancuronium (0.5-1.0 mg) or rocuronium (5-10 mg) were administered to maintain a moderate level of neuromuscular block If visual responses at the adductor pollicis to TOF stimulation of the ulnar nerve,. Neuromuscular blockade was reversed at the completion of surgical wound closure. Intense block (one or two responses to TOF stimulation) was reversed with neostigmine 2mg, and lessintense block was antagonized with neostigmine 1mg. Atropine was administered with the neostigmine. Extubation of the trachea was performed when clinical criteria were met (including a 5-s head lift) and four responses to TOF stimulation were observed. Immediately on arrival in the PACU and 30 minutes later, TOF fade ratios were measured by using acceleromyography . All subjects were examined for symptoms and signs of muscle weakness by one of two researchassistants.PACU nurses recored the SPO2 and LOS.RESULT1 Median TOF ratios on arrival to the PACU and 30 min later were significantly lower in the pancuronium group (0.73 and 0.95, respectively) compared with the rocuronium group (0.88 and 1.02, respectively; P<0.01). Sixteen (60%) of 30 patients in the pancuronium group arrived in the PACU with a TOF ratio <0.7, compared with only 3 (10%) of 30 subjects who received rocuronium (P<0.01). Clinically acceptable neuromuscular recovery (TOF >0.9) was rarely observed in the pancuronium group at this time, compared with the rocuronium group (60% of patients; P<0.01). After 30 min in the PACU, significantly fewer patients who received pancuronium had recovered to a TOF >0.9 (15 of 30 patients versus 28 of 30 patients in the rocuronium group; P<0.01).2. Significantly more patients in the pancuro... |
PDF Full Text Request