BACKGROUND Few studies have examined the specific efficacy of deep neuromuscular blockade(NMB)combined with pneumoperitoneal pressure reduction in laparoscopic radical gastrectomy(LRG)in the elderly.AIM To investigate...BACKGROUND Few studies have examined the specific efficacy of deep neuromuscular blockade(NMB)combined with pneumoperitoneal pressure reduction in laparoscopic radical gastrectomy(LRG)in the elderly.AIM To investigate the application effect of deep neuromuscular blockade(NMB)combined with reduced pneumoperitoneum pressure in LRG for gastric cancer(GC)in elderly patients and its influence on inflammation.METHODS Totally 103 elderly patients with GC treated in our hospital between January 2020 and January 2022 were retrospectively analyzed.Among them,45 patients treated with surgery based on deep NMB and conventional pneumoperitoneum pressure were assigned to the control group,while the rest of the 58 patients who underwent surgery based on deep NMB and reduced pneumoperitoneum pressure were assigned to the observation group.The two groups were compared in the changes of the Leiden-surgical rating scale score,serum tumor necrosis fact-α(TNF-α)and interleukin 6(IL-6)before and after therapy.The visual analogue scale(VAS)was adopted for evaluating the shoulder pain of patients at 8 h,24 h and 48 h after the operation.The driving pressure of the two groups at different time points was also compared.Additionally,the operation time,pneumoperitoneum time,infusion volume,blood loss,extubation time after surgery,residence time in the resuscitation room,TOF%=90%time and post-anesthetic recovery room(PACU)stay time were all recorded,and adverse PACU-associated respiratory events were also recorded.The postoperative hospitalization time and postoperative expenses of the two groups were counted and compared.RESULTS No significant difference was found between the two groups at the time of skin incision,60 minutes since the operation and abdominal closure after surgery(P>0.05).The observation group exhibited significantly lower VAS scores than the control group at 24 and 48h after surgery(P<0.05).Additionally,the observation group had significantly lower driving pressure than the control group at 5 min and 60 min after the establishment of pneumoperitoneum(P<0.05).Additionally,the two groups were similar in terms of the operation time,pneumoperitoneum time,infusion volume,blood loss,extubation time after surgery,residence time in the resuscitation room and TOF%=90%time(P>0.05),and the observation group showed significantly lower TNF-αand IL-6 Levels than the control group at 24 h after therapy(P<0.05).Moreover,the incidence of adverse events was not significantly different between the two groups(P>0.05),and the observation group experienced significantly less hospitalization time and postoperative expenses than the control group(P<0.05).CONCLUSION Deep NMB combined with reduced pneumoperitoneum pressure can decrease the VAS score of shoulder pain and inflammatory reaction,without hindering the surgical vision and increasing adverse PACU-associated respiratory events,and can thus shorten the hospitalization time and treatment cost for patient.展开更多
Neuromuscular blocking agents(NMBAs)were introduced into clinical anesthesia in the 1940s^([1]),and have enabled anesthesiologists to safely anesthetize patients with significant cardiopulmonary diseases.By employing ...Neuromuscular blocking agents(NMBAs)were introduced into clinical anesthesia in the 1940s^([1]),and have enabled anesthesiologists to safely anesthetize patients with significant cardiopulmonary diseases.By employing neuromuscular blockade patient movement could be abolished, without producing excessive cardiovascular depression.展开更多
BACKGROUND Rocuronium,a nondepolarizing muscle relaxant,is usually administered during general anesthesia to facilitate endotracheal intubation and keep patients immobile during the surgery.Sugammadex,the selective re...BACKGROUND Rocuronium,a nondepolarizing muscle relaxant,is usually administered during general anesthesia to facilitate endotracheal intubation and keep patients immobile during the surgery.Sugammadex,the selective reversal agent of rocuronium,fully reverses the neuromuscular blockade(NMB)at the end of surgery.Most reports show that sugammadex rapidly achieves a ratio of train-offour(TOF),a quantitative method of neuromuscular monitoring,of 0.9 which ensures adequate recovery for safe extubation.However,very rare patients with neuromuscular diseases may respond poorly to sugammadex.CASE SUMMARY A 69-year-old female presented with abdominal fullness and nausea,and was diagnosed with gastroparesis.She underwent gastric peroral endoscopic myotomy under general anesthesia with rocuronium(0.7 mg/kg).At the end of surgery,sugammadex 3.6 mg/kg was administered when TOF showed 2 counts.Afterward,the TOF ratio recovered to 0.65 in 30 min.She was awake but could not fully open her eyelids.The tidal volume during spontaneous breathing was low.After additional doses of sugammadex(up to 7.3 mg/kg)in the following 3 h,the TOF ratio was 0.9,and the endotracheal tube was smoothly removed.After excluding possible mechanisms underlying the prolonged recovery course,we speculated our patient may have had an undiagnosed neuromuscular disease,hinted by her involuntary movement of the tongue and mouth.Furthermore,her poor renal function and history of delayed recovery from general anesthesia may be related to the long duration of rocuronium.CONCLUSION In our case,both prolonged rocuronium-induced NMB and poor response to sugammadex were noted.To optimize the dose of rocuronium,perioperative TOF combined with other neuromuscular monitoring is suggested.展开更多
Objective:To observe the incidence of residual neuromuscular blockade at the end of operation and during tracheal extubation, and analyze the risk factors causing residual neuromuscular blockade by judging the degree ...Objective:To observe the incidence of residual neuromuscular blockade at the end of operation and during tracheal extubation, and analyze the risk factors causing residual neuromuscular blockade by judging the degree of muscle relaxation according to clinical signs when after using rocuronium or cis-atracurium in general anesthesia.Methods: 500 adults were implemented with propofol-remifentanil intravenous anesthesia or sevoflurane inhalation anesthesia. Rocuronium and cis-atracurium were given, respectively. The TOFr was observed with blind method by TOF Watch SX monitor during anesthesia.Results: The mean TOFr=0.53±0.38 at the end of operation,including 275 cases of 0<TOFr<0.9 and 112 cases of TOFr=0. The mean TOFr=0.97±0.12 at extubation, including 60 cases of TOFr<0.9. The incidence of residual neuromuscular blockade at extubation showed an increasing trend with the increase of age or body mass index. The average TOFr value at extubation, which interval time over 10 min after neostigmine administration to extubation was significant higher than that of interval time less than 10 min.Conclusions:There has 12% patients with TOFr<0.9 when extubation by estimating rocuronium and cis-atracurium effect with clinical signs and experience, it has a hidden danger of residual neuromuscular blockade. The main risk factors to increasing the incidence of residual neuromuscular blockade are growing old and the short time of administrating muscle relaxants or neostigmine to extubation.展开更多
Complete and reliable neuromuscular reversal is important to successful anaesthetic recovery in the morbidly obese patient undergoing laparoscopic surgery.Our goal was to determine whether sugammadex,a selective rever...Complete and reliable neuromuscular reversal is important to successful anaesthetic recovery in the morbidly obese patient undergoing laparoscopic surgery.Our goal was to determine whether sugammadex,a selective reversal agent is associated with better respiratory recovery than neostigmine following the reversal of anaesthesia-associated neuromuscular blockade by rocuronium in the morbidly obese.Peak Expiratory Flow Rate a surrogate marker for respiratory function,was the primary outcome measured and secondary outcome measures included post-operative nausea and vomiting,pain and head lifting.We found that patients reversed with sugammadex had a significantly higher post-operative PEFR as compared to those reversed with neostigmine and glycopyrrolate group.展开更多
目的:评价舒更葡糖钠对老年肺结核患者肺叶切除术后罗库溴铵血药浓度和肌松恢复的影响。方法:选择2021年9月20日至2022年7月5日首都医科大学附属北京胸科医院行全身麻醉下肺结核肺叶切除术的老年患者68例,采用计算机生成随机序列方法随...目的:评价舒更葡糖钠对老年肺结核患者肺叶切除术后罗库溴铵血药浓度和肌松恢复的影响。方法:选择2021年9月20日至2022年7月5日首都医科大学附属北京胸科医院行全身麻醉下肺结核肺叶切除术的老年患者68例,采用计算机生成随机序列方法随机分为观察组与对照组,每组各34例。在排除观察组4例、对照组3例后,最终纳入观察组30例和对照组31例进行分析。使用0.6 mg/kg罗库溴铵麻醉诱导,术中用罗库溴铵维持4个成串刺激计数(train of four stimulation count,TOFC)为0。术毕当4个成串刺激计数中第2个肌颤搐(T_(2))再现时,观察组给予2 mg/kg舒更葡糖钠拮抗肌松,对照组给予0.05 mg/kg新斯的明+0.025 mg/kg阿托品拮抗肌松。使用液相色谱串联质谱法测定T_(2)、肌松拮抗后5 min和30 min时罗库溴铵的血药浓度;记录从T_(2)分别恢复到4个成串刺激比值(train of four stimulation ratio,TOFR)=0.7、0.8和0.9的时间;记录肌松拮抗前及拮抗后1、2、3、5 min的平均动脉压(MAP)和心率(HR);记录自主呼吸恢复时间、拔管时间和术后住院时间。结果:肌松拮抗后5 min和30 min,观察组罗库溴铵血药浓度分别为(82.9±13.9)μg/ml和(68.1±9.9)μg/ml,均明显高于对照组[(66.1±19.7)μg/ml和(44.0±16.0)μg/ml],差异均有统计学意义(t=3.837、7.046,P值均<0.001)。观察组TOFR恢复到0.7、0.8、0.9的时间分别为(2.0±0.9)min、(2.5±1.1)min和(3.9±2.8)min,均较对照组明显缩短[(7.3±3.6)min、(10.2±5.1)min和(15.8±7.8)min],差异均有统计学意义(t=-7.829、-8.087和-7.878,P值均<0.001)。观察组自主呼吸恢复时间、拨管时间和住院时间分别为(12.1±5.4)min、(15.5±6.6)min和(7.1±2.1)d,对照组自主呼吸恢复时间、拨管时间、住院时间分别为(17.4±7.3)min、(19.5±7.0)min和(8.6±3.4)d,两组比较差异均有统计学意义(t=-3.215、-2.295和-2.065,P=0.002、0.025和0.043)。结论:老年肺结核患者胸腔镜肺叶切除术后使用舒更葡糖钠能够快速增加血浆无活性罗库溴铵血药浓度,快速逆转肌松,明显缩短呼吸恢复时间、拔管时间和住院时间。展开更多
目的在低水平神经肌肉阻滞状态下进行听神经瘤切除术中面神经的保护。方法28例大、中型听神经瘤患者行听神经瘤切除术,术中应用AXONEpochXP神经电生理工作站,根据4个成串刺激(train of four stim-ulation,TOF)和脑电图(EEG)分别监测肌...目的在低水平神经肌肉阻滞状态下进行听神经瘤切除术中面神经的保护。方法28例大、中型听神经瘤患者行听神经瘤切除术,术中应用AXONEpochXP神经电生理工作站,根据4个成串刺激(train of four stim-ulation,TOF)和脑电图(EEG)分别监测肌松程度和麻醉深度,在肿瘤切除过程中通过调节肌松药物和麻醉药物剂量使T4/T1维持在25%～50%,术中监测眼轮匝肌、口轮匝肌、咬肌和斜方肌自由描记肌电图和诱发肌电图,分别反应面神经、三叉神经和副神经功能。于术后1周和术后第6个月分别评估面神经功能。结果28例患者术中均成功探测到面神经走行,电刺激强度为0.1～0.3mA,术中无患者发生体动情况。术后面神经功能保留率良好,术后1周面神经House-Brackmann(H-B)功能分级为Ⅰ级者5例、Ⅱ级者13例,Ⅲ级者8例,Ⅳ级者2例;至术后6个月面神经H-B功能分级Ⅰ级者10例,Ⅱ级者12例,Ⅲ级者5例,Ⅳ级者1例。结论在听神经瘤手术过程中通过电生理监测对面神经进行保护,需要电生理、麻醉和手术医生的配合。在低水平神经肌肉接头阻滞状态下,完全可以达到确保手术安全进行及保护面神经功能的目的。展开更多
基金Zhejiang Health Science and Technology Plan 2022,No.2022KY320。
文摘BACKGROUND Few studies have examined the specific efficacy of deep neuromuscular blockade(NMB)combined with pneumoperitoneal pressure reduction in laparoscopic radical gastrectomy(LRG)in the elderly.AIM To investigate the application effect of deep neuromuscular blockade(NMB)combined with reduced pneumoperitoneum pressure in LRG for gastric cancer(GC)in elderly patients and its influence on inflammation.METHODS Totally 103 elderly patients with GC treated in our hospital between January 2020 and January 2022 were retrospectively analyzed.Among them,45 patients treated with surgery based on deep NMB and conventional pneumoperitoneum pressure were assigned to the control group,while the rest of the 58 patients who underwent surgery based on deep NMB and reduced pneumoperitoneum pressure were assigned to the observation group.The two groups were compared in the changes of the Leiden-surgical rating scale score,serum tumor necrosis fact-α(TNF-α)and interleukin 6(IL-6)before and after therapy.The visual analogue scale(VAS)was adopted for evaluating the shoulder pain of patients at 8 h,24 h and 48 h after the operation.The driving pressure of the two groups at different time points was also compared.Additionally,the operation time,pneumoperitoneum time,infusion volume,blood loss,extubation time after surgery,residence time in the resuscitation room,TOF%=90%time and post-anesthetic recovery room(PACU)stay time were all recorded,and adverse PACU-associated respiratory events were also recorded.The postoperative hospitalization time and postoperative expenses of the two groups were counted and compared.RESULTS No significant difference was found between the two groups at the time of skin incision,60 minutes since the operation and abdominal closure after surgery(P>0.05).The observation group exhibited significantly lower VAS scores than the control group at 24 and 48h after surgery(P<0.05).Additionally,the observation group had significantly lower driving pressure than the control group at 5 min and 60 min after the establishment of pneumoperitoneum(P<0.05).Additionally,the two groups were similar in terms of the operation time,pneumoperitoneum time,infusion volume,blood loss,extubation time after surgery,residence time in the resuscitation room and TOF%=90%time(P>0.05),and the observation group showed significantly lower TNF-αand IL-6 Levels than the control group at 24 h after therapy(P<0.05).Moreover,the incidence of adverse events was not significantly different between the two groups(P>0.05),and the observation group experienced significantly less hospitalization time and postoperative expenses than the control group(P<0.05).CONCLUSION Deep NMB combined with reduced pneumoperitoneum pressure can decrease the VAS score of shoulder pain and inflammatory reaction,without hindering the surgical vision and increasing adverse PACU-associated respiratory events,and can thus shorten the hospitalization time and treatment cost for patient.
基金supported by University of California Davis HealthNIH grant UL1 TR001860 of the University of Califomia Davis Health
文摘Neuromuscular blocking agents(NMBAs)were introduced into clinical anesthesia in the 1940s^([1]),and have enabled anesthesiologists to safely anesthetize patients with significant cardiopulmonary diseases.By employing neuromuscular blockade patient movement could be abolished, without producing excessive cardiovascular depression.
基金Far-Eastern Memorial Hospital,No.FEMH-2022-C-057.
文摘BACKGROUND Rocuronium,a nondepolarizing muscle relaxant,is usually administered during general anesthesia to facilitate endotracheal intubation and keep patients immobile during the surgery.Sugammadex,the selective reversal agent of rocuronium,fully reverses the neuromuscular blockade(NMB)at the end of surgery.Most reports show that sugammadex rapidly achieves a ratio of train-offour(TOF),a quantitative method of neuromuscular monitoring,of 0.9 which ensures adequate recovery for safe extubation.However,very rare patients with neuromuscular diseases may respond poorly to sugammadex.CASE SUMMARY A 69-year-old female presented with abdominal fullness and nausea,and was diagnosed with gastroparesis.She underwent gastric peroral endoscopic myotomy under general anesthesia with rocuronium(0.7 mg/kg).At the end of surgery,sugammadex 3.6 mg/kg was administered when TOF showed 2 counts.Afterward,the TOF ratio recovered to 0.65 in 30 min.She was awake but could not fully open her eyelids.The tidal volume during spontaneous breathing was low.After additional doses of sugammadex(up to 7.3 mg/kg)in the following 3 h,the TOF ratio was 0.9,and the endotracheal tube was smoothly removed.After excluding possible mechanisms underlying the prolonged recovery course,we speculated our patient may have had an undiagnosed neuromuscular disease,hinted by her involuntary movement of the tongue and mouth.Furthermore,her poor renal function and history of delayed recovery from general anesthesia may be related to the long duration of rocuronium.CONCLUSION In our case,both prolonged rocuronium-induced NMB and poor response to sugammadex were noted.To optimize the dose of rocuronium,perioperative TOF combined with other neuromuscular monitoring is suggested.
基金Guangdong science and technology plan project (2013B31800248).
文摘Objective:To observe the incidence of residual neuromuscular blockade at the end of operation and during tracheal extubation, and analyze the risk factors causing residual neuromuscular blockade by judging the degree of muscle relaxation according to clinical signs when after using rocuronium or cis-atracurium in general anesthesia.Methods: 500 adults were implemented with propofol-remifentanil intravenous anesthesia or sevoflurane inhalation anesthesia. Rocuronium and cis-atracurium were given, respectively. The TOFr was observed with blind method by TOF Watch SX monitor during anesthesia.Results: The mean TOFr=0.53±0.38 at the end of operation,including 275 cases of 0<TOFr<0.9 and 112 cases of TOFr=0. The mean TOFr=0.97±0.12 at extubation, including 60 cases of TOFr<0.9. The incidence of residual neuromuscular blockade at extubation showed an increasing trend with the increase of age or body mass index. The average TOFr value at extubation, which interval time over 10 min after neostigmine administration to extubation was significant higher than that of interval time less than 10 min.Conclusions:There has 12% patients with TOFr<0.9 when extubation by estimating rocuronium and cis-atracurium effect with clinical signs and experience, it has a hidden danger of residual neuromuscular blockade. The main risk factors to increasing the incidence of residual neuromuscular blockade are growing old and the short time of administrating muscle relaxants or neostigmine to extubation.
文摘Complete and reliable neuromuscular reversal is important to successful anaesthetic recovery in the morbidly obese patient undergoing laparoscopic surgery.Our goal was to determine whether sugammadex,a selective reversal agent is associated with better respiratory recovery than neostigmine following the reversal of anaesthesia-associated neuromuscular blockade by rocuronium in the morbidly obese.Peak Expiratory Flow Rate a surrogate marker for respiratory function,was the primary outcome measured and secondary outcome measures included post-operative nausea and vomiting,pain and head lifting.We found that patients reversed with sugammadex had a significantly higher post-operative PEFR as compared to those reversed with neostigmine and glycopyrrolate group.
文摘目的:评价舒更葡糖钠对老年肺结核患者肺叶切除术后罗库溴铵血药浓度和肌松恢复的影响。方法:选择2021年9月20日至2022年7月5日首都医科大学附属北京胸科医院行全身麻醉下肺结核肺叶切除术的老年患者68例,采用计算机生成随机序列方法随机分为观察组与对照组,每组各34例。在排除观察组4例、对照组3例后,最终纳入观察组30例和对照组31例进行分析。使用0.6 mg/kg罗库溴铵麻醉诱导,术中用罗库溴铵维持4个成串刺激计数(train of four stimulation count,TOFC)为0。术毕当4个成串刺激计数中第2个肌颤搐(T_(2))再现时,观察组给予2 mg/kg舒更葡糖钠拮抗肌松,对照组给予0.05 mg/kg新斯的明+0.025 mg/kg阿托品拮抗肌松。使用液相色谱串联质谱法测定T_(2)、肌松拮抗后5 min和30 min时罗库溴铵的血药浓度;记录从T_(2)分别恢复到4个成串刺激比值(train of four stimulation ratio,TOFR)=0.7、0.8和0.9的时间;记录肌松拮抗前及拮抗后1、2、3、5 min的平均动脉压(MAP)和心率(HR);记录自主呼吸恢复时间、拔管时间和术后住院时间。结果:肌松拮抗后5 min和30 min,观察组罗库溴铵血药浓度分别为(82.9±13.9)μg/ml和(68.1±9.9)μg/ml,均明显高于对照组[(66.1±19.7)μg/ml和(44.0±16.0)μg/ml],差异均有统计学意义(t=3.837、7.046,P值均<0.001)。观察组TOFR恢复到0.7、0.8、0.9的时间分别为(2.0±0.9)min、(2.5±1.1)min和(3.9±2.8)min,均较对照组明显缩短[(7.3±3.6)min、(10.2±5.1)min和(15.8±7.8)min],差异均有统计学意义(t=-7.829、-8.087和-7.878,P值均<0.001)。观察组自主呼吸恢复时间、拨管时间和住院时间分别为(12.1±5.4)min、(15.5±6.6)min和(7.1±2.1)d,对照组自主呼吸恢复时间、拨管时间、住院时间分别为(17.4±7.3)min、(19.5±7.0)min和(8.6±3.4)d,两组比较差异均有统计学意义(t=-3.215、-2.295和-2.065,P=0.002、0.025和0.043)。结论:老年肺结核患者胸腔镜肺叶切除术后使用舒更葡糖钠能够快速增加血浆无活性罗库溴铵血药浓度,快速逆转肌松,明显缩短呼吸恢复时间、拔管时间和住院时间。
文摘目的在低水平神经肌肉阻滞状态下进行听神经瘤切除术中面神经的保护。方法28例大、中型听神经瘤患者行听神经瘤切除术,术中应用AXONEpochXP神经电生理工作站,根据4个成串刺激(train of four stim-ulation,TOF)和脑电图(EEG)分别监测肌松程度和麻醉深度,在肿瘤切除过程中通过调节肌松药物和麻醉药物剂量使T4/T1维持在25%～50%,术中监测眼轮匝肌、口轮匝肌、咬肌和斜方肌自由描记肌电图和诱发肌电图,分别反应面神经、三叉神经和副神经功能。于术后1周和术后第6个月分别评估面神经功能。结果28例患者术中均成功探测到面神经走行,电刺激强度为0.1～0.3mA,术中无患者发生体动情况。术后面神经功能保留率良好,术后1周面神经House-Brackmann(H-B)功能分级为Ⅰ级者5例、Ⅱ级者13例,Ⅲ级者8例,Ⅳ级者2例;至术后6个月面神经H-B功能分级Ⅰ级者10例,Ⅱ级者12例,Ⅲ级者5例,Ⅳ级者1例。结论在听神经瘤手术过程中通过电生理监测对面神经进行保护,需要电生理、麻醉和手术医生的配合。在低水平神经肌肉接头阻滞状态下,完全可以达到确保手术安全进行及保护面神经功能的目的。
