13 ΙΟΥΛΙΟΥ 2018

ΔΗΜΟΣΙΕΥΣΕΙΣ

Deep neuromuscular block improves the surgical conditions for laryngeal microsurgery

Deep neuromuscular block improves the surgical conditions for laryngeal microsurgery

Έκδοση:

Br J Anaesth. 2015 Dec;115(6):867-72. doi: 10.1093/bja/aev368.

Συγγραφέας:

Kim HJ1, Lee K1, Park WK1, Lee BR1, Joo HM1, Koh YW2, Seo YW2, Kim WS3, Yoo YC4.

Abstract

BACKGROUND:

Adequate neuromuscular block is required throughout laryngeal microsurgery. We hypothesized that the surgical conditions would improve under a deeper level of rocuronium-induced neuromuscular block.

METHODS:

Seventy-two patients undergoing laryngeal microsurgery were randomly allocated to either the 'post-tetanic counts 1-2' (PTC1-2) group or the 'train-of-four counts 1-2' (TOFcount1-2) group according to the level of neuromuscular block used. Two different doses of rocuronium (1.2 or 0.5 mg kg(-1)) were used after anaesthetic induction, and two respective targets of neuromuscular block (post-tetanic counts ≤2 or train-of-four count of 1 or 2) were used. Surgical conditions were assessed by the surgeon using a five-point rating scale (extremely poor/poor/acceptable/good/optimal), and clinically acceptable surgical conditions were defined as those which were rated acceptable, good, or optimal. The occurrence of vocal cord movement and postoperative adverse events was assessed.

RESULTS:

The surgical conditions were significantly different between the PTC1-2 and TOFcount1-2 groups (extremely poor/poor/acceptable/good/optimal: 0/2/1/7/26 and 3/10/2/14/7, respectively, P<0.001). The incidence of clinically acceptable surgical conditions was significantly higher in the PTC1-2 group than in the TOFcount1-2 group (94 vs 64%, P=0.003). The percentage of patients who exhibited vocal cord movement was significantly lower in the PTC1-2 group than in the TOFcount1-2 group (3 vs 39%, P<0.001). The incidence of postoperative adverse events was not significantly different except for the less frequent occurrence of mouth dryness in the PTC1-2 group (P=0.035).

CONCLUSIONS:

Deep neuromuscular block (post-tetanic count of 1-2) surgical conditions in patients undergoing laryngeal microsurgery improves.

CLINICAL TRIAL REGISTRATION:

NCT01980069.

© The Author 2015. Published by Oxford University Press on behalf of the British Journal of Anaesthesia. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

KEYWORDS:

larynx; neuromuscular blockade; neuromuscular monitoring

PMID:26582847

 DOI:10.1093/bja/aev368

Δείτε το Abstract μέσα από το PubMed