Effects of rocuronium on limb ischemia-reperfusion injury in patients undergoing total knee arthroplasty
10.3760/cma.j.cn131073.20200221.00507
- VernacularTitle:罗库溴铵对膝关节置换术患者肢体缺血再灌注损伤的影响
- Author:
Hui CHEN
1
;
Kunpeng ZHOU
;
Ying HE
;
Jingqiu WEI
;
He LIU
;
Yueying ZHANG
Author Information
1. 徐州医科大学附属医院麻醉科 221002
- From:
Chinese Journal of Anesthesiology
2020;40(5):543-547
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To evaluate the effects of rocuronium on limb ischemia-reperfusion injury in the patients undergoing total knee arthroplasty.Methods:Ninety patients of both sexes, aged 50-80 yr, of American Society of Anesthesiologists physical status Ⅰ or Ⅱ, with body mass index<30 kg/cm 2, scheduled for elective unilateral knee arthroplasty under general anesthesia combined with femoral nerve block from January 2019 to October 2019, were divided into 3 groups ( n=30 each) using a random number table method: normal saline group (group S), rocuronium 0.6 mg/kg group (group RL) and rocuronium 1.2 mg/kg group (group RH). Anesthesia was induced by intravenous injection of midazolam, etomidate, sufentanil and rocuronium 0.6 mg/kg (group RL) or 1.2 mg/kg (group RH) or equal volume of normal saline (group S). Mechanical ventilation was performed after placement of laryngeal mask to maintain P ETCO 2 35-45 mmHg.Femoral nerve block was performed under ultrasound guidance.Anesthesia was maintained by inhaling 1% sevoflurane and intravenous infusion of propofol and remifentanil to maintain entropy index at 40-60 during operation.Patient-controlled intravenous analgesia was performed with sufentanil after surgery to maintain visual analogue scale score ≤ 4 points.When visual analogue scale score was > 4, flurbiprofen axetil 100 mg was intravenously injected.The vastus medialis muscle at the edge of the incision was obtained at 60 min after inflation to determine the expression of dystrophin by immunohistochemistry.Arterial blood samples were collected immediately after inflation of the tourniquet, at 60 min after inflation, and at 5 and 30 min after deflation for determination of the serum malondialdehyde (MDA) concentrations by the thiobarbituric acid method.The effective pressing times of the analgesic pump and consumption of sufentanil and flurbiprofen axetil were recorded within 48 h after operation.The occurrence of responses to tourniquet and residual muscle relaxation during recovery from anesthesia, the first postoperative off-bed time and postoperative length of hospital stay were recorded.The thigh girth was measured before operation and at 24 and 48 h after operation, and the difference after and before operation was calculated.The range of motion of knees of the operated limb and tourniquet-related complications in the early postoperative period (3 days) and in the long-term postoperative period (3 months) were recorded. Results:Compared with group S, the expression of dystrophin in skeletal muscle was significantly up-regulated, the concentration of serum MDA was decreased at 30 min after deflation, and the difference in thigh girth at 24 and 48 h after operation was decreased in group RH, and the range of motion of knees was significantly increased at 3 days and 3 months after operation, and the first postoperative off-bed time was shortened in group RH and group RL ( P<0.05). Compared with group RL, the range of motion of knees was significantly increased at 3 days and 3 months after operation, and the first postoperative off-bed time was shortened in group RH ( P<0.05). There was no significant difference in the incidence of responses to tourniquet, postoperative length of hospital stay, effective pressing times of the analgesic pump, postoperative consumption of sufentanil and flurbiprofen axetil, and the incidence of tourniquet-related complications in the early and long-term postoperative periods among the three groups ( P>0.05). No residual muscle relaxation was found during recovery from anesthesia in three groups. Conclusion:Rocuronium 1.2 mg/kg can reduce limb ischemia-reperfusion injury in the patients undergoing total knee arthroplasty.
