| Objective: Postoperative residual curarization(PORC)is known to be a common but frequently overlooked complication after general anesthesia.It may lead to adverse respiratory events(such as hypoxaemia,airway obstruction,aspiration,atelectasis and pulmonary edema),which prolong hospital stay and endanger the postoperative patients' lives.Neuromuscular transmission monitor is considered as an objective and quantitative equipment to assess the degree of neuromuscular function recovery.TOFR?0.9 is generally accepted as the threshold value that the airway protective reflex is completely resumed,then extubation is safe.At present neuromuscular transmission monitor is not available in our hospital.The time to extubation is decided by patients' clinical signs and anesthetists' personal experience,which can not ensure that each patient has not residual neuromuscular blockade before extubation.Therefore,researching the incidence of PORC and exploring its related factors is significant to instruct safer clinical anesthesia work.Methods: 119 patients were admitted to this study.All patients(age?18 years,ASA ?,?or ?)had selective surgery in general anesthesia.The procedure of anesthesia induction and maintenance were in the routine method.After operation,muscular strength was tested by the TOF-Watch SX acceleromyograph before extubation,arrived in the PACU or before leaving the operation room.TOFR?0.9 was defined incompletely neuromuscular recovery after general anesthesia.The following informations were recorded: gender,age,height,weight,ASA physical status,illness history,surgery types,anesthesia duration,operation duration,blood loss,inhalation sevoflurane or not,inhalation duration and concentration,the duration from the last using of muscle relaxants to extubation,whether used of neostigmine,the dose of neostigmine and the total dose of muscle relaxants.Patients were classified into non–PORC group(TOFR?0.9)or PORC(TOFR<0.9)group.the two groups were compared in above variables to analyze the related factors of residual neuromuscular blockade.Results: 1 119 patients were included in the study.Train-of-four ratio was less than 0.9 in 33 patients(33/119)before extubation.The incidence of PORC was 27.7% before extubation.61 patients were transported to the postanesthesia care unit and train-of-four ratio was less than 0.9 in 15 patients(15/61).The incidence of PORC was 24.6 % arriving at the postanesthesia care unit.Other patients were transported to the sickroom directly and train-of-four ratio was less than 0.9 in 3 patients(3/58).The incidence of PORC was 5.2% before leaving the operation room.2 In this study surgery included orthopedic surgery,abdominal surgery and other surgery.The incidence of PORC was 24.3%,63.2% and 11.5% respectively in orthopedic surgery,abdominal surgery and other surgery before extubation.3 Cis-atracurium was used in all patients.Neostigmine was used in 16 out of l19 patients when the surgery was finished.The proportion of using of neostigmine was 13.4%.4 Patients in the PORC group were older than the non-PORC group in average(57.9±11.0 VS 48.2±15.7).The duration of operation,anesthesia and inhalation in the PORC group was longer than the non-PORC group: operation duration [154.1±42.6 VS 120(55)],anesthesia duration [194.5±44.8 VS 170(61.3)] and inhalation duration [45(45)VS 20(45)].Compared with the non-PORC group the interval between the last using of muscle relaxants and extubation was short in the PORC group [70(25)VS 102.5(40)].The total dose of muscle relaxants and blood loss in the PORC group were more than in the non-PORC group : muscle relaxants [25(6)VS 20(10)] and blood loss[450(350)VS 275(300)],p?0.05.Conclusion:1 The incidence of PORC was 27.7% before extubation.2 Age,the duration of operation,anesthesia and inhalation,blood loss,the total dose of muscle relaxants and the interval between the last using of muscle relaxants and extubation were the related factors of PORC after general anesthesia. |
PDF Full Text Request