Clinical Observation:the Necessity Of Neuromuscular Monitoring In Postanesthesia Care Unit

Objective:The aim of this clinical trail was to determine the incidence of residual neuromuscular blockade in a cohort of patients in the postanesthesia care unit(PACU)determined via neuromuscular monitor after general anesthesia.Methods:Three hundred and six patients,aged 20~90 yr,BMI16-28kg/m2,of American Society of Anesthesiology physical status Ⅰ-Ⅲ,scheduled for surgery under general anesthesia,were divided into either endotracheal extubation group or intubation group according to weather the endotracheal was extubated or not.The cisatracurium was the only nuromuscular blockade agent used during general anesthesia.The endotracheal extubation group monitored the train of four ratios(TOFr)using nuromuscular monitor at the time patients transferred from operation room to the postanesthesia care unit(T1),30 minutes after administration to the postanesthesia care unit(T2),the time of patients discharged from the postanesthesia care unit(T3)and the endotracheal intubation group monitored the train of four ratios(TOFr)at the timebefore tracheal extubation(T4),30 minutes after tracheal extubation(T5),the time of patients discharged from PACU(T6).The other parameters of patients were also recorded including demographic information,the anesthesia agents and the muscle relaxation antagonism,the length of stay in the postanesthesia care unit and the incidence of hypoxemia.Results:There were forty-four patients in the endotracheal extubation group and two hundred and sixty-two patients in the endotracheal intubation group.The incidence of residual nuromuscular blockade(RNMB)in extubation group was 61.4%(T1),43.2%(T2),15.9%(T3)respectively;And 76.7%(T4),46.6%(T5),21%(T6)in intubation group respectively;In the intubation group,the incidence of RNMB between time elapsed from the last administration of cisatracurium to tracheal extubation ≤90minutes was more than>90 minutes(P<0.01);The incidence of RNMB in the the elderly group(66~90 yr)was higher than younger group(20~40 yr)(P<0.05),The length stay in PACU of the patients with TOF ratios<0.9 was longer than the patients with TOF ratios≥0.9 when discharge from PACU(P<0.05),there were no statistically significant different in tracheal extubation group;The mean time from using muscle relaxation antagonism to TOF ratio reach 0.9 was(8.6±5.0)min;The incidence of hypoxemia was 7.2%.Conclusion:The incidence of residual neuromuscular blockades was very common in the PACU.It is necessary to monitor the nuromuscular blockade using neuromuscular monitoring before the determination of the extubation and the patients transferred to general surgical floor.The antagonism of nuromuscular blockade agent is a safe measure to reduce the incidence of residual neuromscular blockade.