Rate of residual neuromuscular block using single-dose rocuronium in general anesthesia for ENT surgery: a retrospective cohort study
Abstract Introduction NMB facilitates intubating conditions in general anesthesia. However, it is associated with significant residual postoperative paralysis and morbidity. Objective To investigate the rate of underdiagnosed residual NMB based on two TOFR criteria (< 0.91 and < 1.00). Methods...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2023-04-01
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| Series: | BMC Anesthesiology |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12871-023-02027-x |
| _version_ | 1797556925296017408 |
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| author | Orlando Carrillo-Torres María Guadalupe Pliego-Sánchez Víctor Joshua Pérez-Muñoz Jennifer Sánchez-Jurado Verónica Camacho-Vacherón José Damián Carrillo-Ruíz |
| author_facet | Orlando Carrillo-Torres María Guadalupe Pliego-Sánchez Víctor Joshua Pérez-Muñoz Jennifer Sánchez-Jurado Verónica Camacho-Vacherón José Damián Carrillo-Ruíz |
| author_sort | Orlando Carrillo-Torres |
| collection | DOAJ |
| description | Abstract Introduction NMB facilitates intubating conditions in general anesthesia. However, it is associated with significant residual postoperative paralysis and morbidity. Objective To investigate the rate of underdiagnosed residual NMB based on two TOFR criteria (< 0.91 and < 1.00). Methods We performed a retrospective study adhering to STROBE guidelines. We included patients undergoing ENT surgery using single-dose neuromuscular block for balanced general anesthesia from June to December 2018. We collected demographic and anthropometric data, ASA score, NMBA dose, TOFR recordings at 5, 30 and 60 min and end of the surgery, anesthesia and surgery time, and administration of reversal agent. Statistical analysis included descriptive and dispersion measures statistics, curve and cross tables for residual NMB on different TOFR criteria with sub-analysis for AR, RR, and OR in patients over 65 years old. Results We included 57 patients, mean age 41; 43 females and 14 males. Mean anesthetic and surgical time were 139.4 and 116.1 min, respectively. All the patients received rocuronium under a mean ponderal single-dose of 0.48 mg/kg. Residual NMB rates were 29.9 and 49.1% for a TOFR < 0.91 and < 1.00, respectively. Older adults had an OR of 6.08 for residual NMB. Conclusions The rate of residual NMB was 29.9 to 49.1%, depending on the criteria used (TOFR < 0.91 and < 1.00, respectively). Patients above 65 years old had an increased risk of residual NMB (6.08 OR) and clinical symptoms related to residual NMB (11.75 OR). We recommend future research aiming to provide a specific surveillance protocol for patients above 65 years old, including shorter-action NMB, early reversal, and prolonged surveillance using the TOFR criteria of < 1.00 to identify patients at risk of residual NMB readily. |
| first_indexed | 2024-03-10T17:10:04Z |
| format | Article |
| id | doaj.art-5ded20b69fab4466852f10811e6a675c |
| institution | Directory Open Access Journal |
| issn | 1471-2253 |
| language | English |
| last_indexed | 2024-03-10T17:10:04Z |
| publishDate | 2023-04-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Anesthesiology |
| spelling | doaj.art-5ded20b69fab4466852f10811e6a675c2023-11-20T10:42:05ZengBMCBMC Anesthesiology1471-22532023-04-0123111410.1186/s12871-023-02027-xRate of residual neuromuscular block using single-dose rocuronium in general anesthesia for ENT surgery: a retrospective cohort studyOrlando Carrillo-Torres0María Guadalupe Pliego-Sánchez1Víctor Joshua Pérez-Muñoz2Jennifer Sánchez-Jurado3Verónica Camacho-Vacherón4José Damián Carrillo-Ruíz5Anesthesiology Service at Mexico General HospitalAnesthesiology Service at Mexico General HospitalAnesthesiology Service at Mexico General HospitalAnesthesiology Service at Mexico General HospitalAnesthesiology Service at Mexico General HospitalResearch Direction & Neurosurgery Service at Hospital General de MéxicoAbstract Introduction NMB facilitates intubating conditions in general anesthesia. However, it is associated with significant residual postoperative paralysis and morbidity. Objective To investigate the rate of underdiagnosed residual NMB based on two TOFR criteria (< 0.91 and < 1.00). Methods We performed a retrospective study adhering to STROBE guidelines. We included patients undergoing ENT surgery using single-dose neuromuscular block for balanced general anesthesia from June to December 2018. We collected demographic and anthropometric data, ASA score, NMBA dose, TOFR recordings at 5, 30 and 60 min and end of the surgery, anesthesia and surgery time, and administration of reversal agent. Statistical analysis included descriptive and dispersion measures statistics, curve and cross tables for residual NMB on different TOFR criteria with sub-analysis for AR, RR, and OR in patients over 65 years old. Results We included 57 patients, mean age 41; 43 females and 14 males. Mean anesthetic and surgical time were 139.4 and 116.1 min, respectively. All the patients received rocuronium under a mean ponderal single-dose of 0.48 mg/kg. Residual NMB rates were 29.9 and 49.1% for a TOFR < 0.91 and < 1.00, respectively. Older adults had an OR of 6.08 for residual NMB. Conclusions The rate of residual NMB was 29.9 to 49.1%, depending on the criteria used (TOFR < 0.91 and < 1.00, respectively). Patients above 65 years old had an increased risk of residual NMB (6.08 OR) and clinical symptoms related to residual NMB (11.75 OR). We recommend future research aiming to provide a specific surveillance protocol for patients above 65 years old, including shorter-action NMB, early reversal, and prolonged surveillance using the TOFR criteria of < 1.00 to identify patients at risk of residual NMB readily.https://doi.org/10.1186/s12871-023-02027-xNeuromuscular block agentsResidual neuromuscular blockTrain-of-fourRNMARNMBTOF |
| spellingShingle | Orlando Carrillo-Torres María Guadalupe Pliego-Sánchez Víctor Joshua Pérez-Muñoz Jennifer Sánchez-Jurado Verónica Camacho-Vacherón José Damián Carrillo-Ruíz Rate of residual neuromuscular block using single-dose rocuronium in general anesthesia for ENT surgery: a retrospective cohort study BMC Anesthesiology Neuromuscular block agents Residual neuromuscular block Train-of-four RNMA RNMB TOF |
| title | Rate of residual neuromuscular block using single-dose rocuronium in general anesthesia for ENT surgery: a retrospective cohort study |
| title_full | Rate of residual neuromuscular block using single-dose rocuronium in general anesthesia for ENT surgery: a retrospective cohort study |
| title_fullStr | Rate of residual neuromuscular block using single-dose rocuronium in general anesthesia for ENT surgery: a retrospective cohort study |
| title_full_unstemmed | Rate of residual neuromuscular block using single-dose rocuronium in general anesthesia for ENT surgery: a retrospective cohort study |
| title_short | Rate of residual neuromuscular block using single-dose rocuronium in general anesthesia for ENT surgery: a retrospective cohort study |
| title_sort | rate of residual neuromuscular block using single dose rocuronium in general anesthesia for ent surgery a retrospective cohort study |
| topic | Neuromuscular block agents Residual neuromuscular block Train-of-four RNMA RNMB TOF |
| url | https://doi.org/10.1186/s12871-023-02027-x |
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