Efficacy And Safety Of Neuromuscular Blockade On Overweight Patients Undergoing Nasopharyngeal Surgery: A Randomized Controlled Trials

ObjectiveTo compare the anesthetic regimens of muscle relaxant agents and antagonists on overweight patients undergoing nasopharyngeal surgery.MethodsThis prospective,randomized,double-blind study was conducted in overweight patients of either sex,ASA I-II,18～75 years,undergoing nasopharyngeal surgery.They were randomly assigned into three groups,with different muscle relaxant agents and antagonists: rocuronium and sugammadex(Group RS),rocuronium and neostigmine(Group RN),and cisatracurium and neostigmine(Group CN).Antagonists were given at reappearance of a train-of-four(TOF)score of 2 after operation.Then we compared the efficacy and safety indexes of three groups.The effective indexes include: the onset time of neuromuscular relaxation,the time of intubation,intubation conditions and the time from the administration of antagonist to the recovery of TOF to 0.9.Safety indexes include: postoperative residual curarization(PORC),hemodynamic index stability,postoperative pain,postoperative nausea and vomiting,postoperative arrhythmia and postoperative respiratory events.Results102 patients were randomized and assigned into Group RS(n=34),Group RN(n=34),Group CN(n=34).The overall findings were as follows:1.Onset time of neuromuscular relaxation in the Group RS and the Group RN(110s and 120s)were shorter than Group group(183s).2.Time from administration of antagonist to recovery of the TOF ratio to 0.9 was shorter in Group RS(3.3min)than Group RN(20.7min)and Group CN(19.1min),P<0.01;3.The changes of hemodynamic parameters,including systolic blood pressure,diastolic blood pressure,mean arterial pressure,and heart rate,were significantly higher in the Group RN and the Group CN than the changes in RS group,from the time of administration of muscle relaxant antagonists to extubation,P <0.01;4.The incidence rate of PORC was significantly lower in group RS(5.9%)than other groups(41.2%),P<0.01;5.The postoperative visual analog scale pain scores were lowest in group RS(0.7 in Group RS vs 2.9 in Group RN and 3.0 in Group CN),P<0.01.ConclusionFor overweight patients accepted nasopharyngeal surgery,the use of rocuronium with sugammadex had the shortest onset time of neuromuscular relaxation,accelerated the reversion of neuromuscular blockade,effectively reduced the occurrence of PORC,relieved postoperative pain,and maintained hemodynamic stability before extubation.The combination of rocuronium and sugammadex showed obvious advantages in terms of efficacy and safety,and may be the better combination of neuromuscular relaxants and antagonists for overweight patients undergoing nasopharyngeal surgery.