Clinical observation on the safety of muscle relaxants in patients undergoing laryngeal surgery under general anesthesia
10.3760/cma.j.cn114015-20230425-00308
- VernacularTitle:喉科全麻手术患者应用肌松药安全性临床观察
- Author:
Na LIN
1
;
Mengmeng ZHAO
1
;
Guyan WANG
1
Author Information
1. 首都医科大学附属北京同仁医院麻醉科，北京 100730
- Publication Type:Journal Article
- Keywords:
Otorhinolaryngologic surgical procedures;
Anesthesia, general;
Anesthesia recovery period;
Safety;
Neuromuscular nondepolarzing agents
- From:
Adverse Drug Reactions Journal
2023;25(6):332-338
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To observe the occurrence of residual neuromuscular blockade (RNMB) in post anesthesia care unit (PACU) in patients undergoing selective laryngeal surgery under general anesthesia and provide reference for improving the safety of muscle relaxants during the perioperative period.Methods:The adult patients who underwent laryngeal surgery in Beijing Tongren Hospital, Capital Medical University from July 2020 to March 2021 were collected. According to the muscle relaxants used in the surgery, the patients were divided into rocuronium bromide group, mivacurium chloride group, and cisatracurium group. The general information of patients in the different groups [age, body mass index, American Society of Anesthesiologists (ASA) classification, etc.], duration of surgery, anesthesia time, stay time in PACU, and recovery of neuromuscular function (expressed using train of four ratio, abbreviated as TOFr) were recorded and analyzed. The ability to speak and raise one′s head in PACU, as well as the occurrence of adverse events such as gastroesophageal reflux, aspiration, and dyspnea were also recorded.Results:A total of 320 patients were enrolled in the study, including 188 males (58.8%) and 132 females (41.2%), with a mean age of (50±13) years. The duration of surgery was (38.6±30.1) minutes, anesthesia time was (57.2±32.8) minutes, and stay time in PACU was (34.6±11.4) minutes. There were 115, 141, and 64 patients in the rocuronium bromide, mivacurium chloride, and cisatracurium groups, respectively. The differences in age, body mass index, and ASA grade in patients among the 3 groups were not significant (all P>0.05). The anesthesia time and duration of surgery in patients of the mivacurium chloride group were shorter than those of the rocuronium bromide and cisatracurium groups [(43.53±23.90) minutes vs. (67.54±37.72) minutes and (68.84±29.34) minutes; (26.87±22.18) minutes vs. (47.16±34.83) minutes and (48.84±27.57) minutes], and the differences were statistically significant (all P<0.01). The difference in stay time in PACU among the 3 groups was not statistically significant ( P>0.05). At the moment of entering PACU, 272 (88.6%) of 320 patients had TOFr<0.9, of which 105 (32.8%) had TOFr<0.7; when leaving PACU, the TOFr of all patients was>0.9. Except the time point of leaving PACU, TOFr in the rocuronium bromide group at the other time points were higher than those in the cisatracurium group (all P<0.01). Except the 2 time points of the moment of entering and leaving PACU, TOFr in the mivacurium chloride group was higher than those in the cisatracurium group (all P<0.01). At the moment of entering PACU and 5 minutes after entering PACU, TOFr in the mivacurium chloride group was lower than those in the rocuronium bromide group (all P<0.05). When entering PACU, 79 of 320 patients had saturation of pulse oximetry (SpO 2)<0.95 and the difference in SpO 2 among the 3 groups was statistically significant ( P=0.029), of which 4 cases (6.25%) had SpO 2<0.90 in the cisatracurium group, and the incidence of hypoxemia was higher than that in the other 2 groups. The differences in ability of speach and head lifting of patients among the 3 groups when entering PACU were statistically significant ( P=0.036, P<0.001). No adverse events such as reflux, or aspiration, dyspnea occurred in patients in PACU. Conclusions:The incidence of RNMB in patients undergoing laryngeal surgery entering PACU immediately is high and the degree of RNMB is more severe, with TOFr gradually increasing and RNMB decreasing over time. The patients who receive cisatracurium have a high incidence and severity of postoperative RNMB. Routine monitoring and neuromuscular monitoring in PACU are beneficial for patients′ perioperative safety.
