Use of protocol and evaluation of postoperative residual curarization incidence in the absence of intraoperative acceleromyography - Randomized clinical trial

Use of protocol and evaluation of postoperative residual curarization incidence in the absence of intraoperative acceleromyography - Randomized clinical trial

Abstract Objective Evaluate the incidence of postoperative residual curarization (PORC) in the post-anesthesia care unit (PACU) after the use of protocol and absence of intraoperative acceleromyography (AMG). Methods Randomized clinical trial with 122 patients allocated into two groups (protocol and control). Protocol group received initial and additional doses of rocuronium (0.6 mg·kg-1 and 10 mg, respectively); the use of rocuronium was avoided in the final 45 min; blockade reversal with neostigmine (50 µg·kg-1); time ≥15 min between reversion and extubation. Control: initial and additional doses of rocuronium, blockade reversal, neostigmine dose, and extubation time, all at the discretion of the anesthesiologist. AMG was used in the PACU and PORC considered at T4/T1 ratio <1.0. Results The incidence of PORC was lower in protocol group than in control group (25% vs. 45.2%, p = 0.02). In control group, total dose of rocuronium was higher in patients with PORC than without PORC (0.43 vs. 0.35 mg·kg-1·h-1, p = 0.03) and the time interval between the last administration of rocuronium and neostigmine was lower (75.0 vs. 101.0 min, p < 0.01). In protocol group, there was no difference regarding the analyzed parameters (with PORC vs. without PORC). Considering the entire study population and the presence or absence of PORC, total dose of rocuronium was higher in patients with PORC (0.42 vs. 0.31 mg·kg-1·h-1, p = 0.01), while the time interval between the last administration of rocuronium and neostigmine was lower (72.5 vs. 99.0 min, p ≤ 0.01). Conclusion The proposed systematization reduced PORC incidence in PACU in the absence of intraoperative AMG.

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Main Authors: Santos,Filipe Nadir Caparica, Braga,Angelica de Fátima de Assunção, Ribeiro,Carla Josefine Barbosa de Lima, Braga,Franklin Sarmento da Silva, Carvalho,Vanessa Henriques, Junqueira,Fernando Eduardo Feres
Format: Digital revista
Language:English
Published: Sociedade Brasileira de Anestesiologia 2017
Online Access:http://old.scielo.br/scielo.php?script=sci_arttext&pid=S0034-70942017000600592
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spelling oai:scielo:S0034-709420170006005922017-11-29Use of protocol and evaluation of postoperative residual curarization incidence in the absence of intraoperative acceleromyography - Randomized clinical trialSantos,Filipe Nadir CaparicaBraga,Angelica de Fátima de AssunçãoRibeiro,Carla Josefine Barbosa de LimaBraga,Franklin Sarmento da SilvaCarvalho,Vanessa HenriquesJunqueira,Fernando Eduardo Feres Neuromuscular blockers Rocuronium Neostigmine Postoperative residual curarization Quantitative neuromuscular monitoring Acceleromyography Abstract Objective Evaluate the incidence of postoperative residual curarization (PORC) in the post-anesthesia care unit (PACU) after the use of protocol and absence of intraoperative acceleromyography (AMG). Methods Randomized clinical trial with 122 patients allocated into two groups (protocol and control). Protocol group received initial and additional doses of rocuronium (0.6 mg·kg-1 and 10 mg, respectively); the use of rocuronium was avoided in the final 45 min; blockade reversal with neostigmine (50 µg·kg-1); time ≥15 min between reversion and extubation. Control: initial and additional doses of rocuronium, blockade reversal, neostigmine dose, and extubation time, all at the discretion of the anesthesiologist. AMG was used in the PACU and PORC considered at T4/T1 ratio <1.0. Results The incidence of PORC was lower in protocol group than in control group (25% vs. 45.2%, p = 0.02). In control group, total dose of rocuronium was higher in patients with PORC than without PORC (0.43 vs. 0.35 mg·kg-1·h-1, p = 0.03) and the time interval between the last administration of rocuronium and neostigmine was lower (75.0 vs. 101.0 min, p < 0.01). In protocol group, there was no difference regarding the analyzed parameters (with PORC vs. without PORC). Considering the entire study population and the presence or absence of PORC, total dose of rocuronium was higher in patients with PORC (0.42 vs. 0.31 mg·kg-1·h-1, p = 0.01), while the time interval between the last administration of rocuronium and neostigmine was lower (72.5 vs. 99.0 min, p ≤ 0.01). Conclusion The proposed systematization reduced PORC incidence in PACU in the absence of intraoperative AMG.info:eu-repo/semantics/openAccessSociedade Brasileira de AnestesiologiaRevista Brasileira de Anestesiologia v.67 n.6 20172017-12-01info:eu-repo/semantics/articletext/htmlhttp://old.scielo.br/scielo.php?script=sci_arttext&pid=S0034-70942017000600592en10.1016/j.bjane.2017.02.003
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country Brasil
countrycode BR
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databasecode rev-scielo-br
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libraryname SciELO
language English
format Digital
author Santos,Filipe Nadir Caparica
Braga,Angelica de Fátima de Assunção
Ribeiro,Carla Josefine Barbosa de Lima
Braga,Franklin Sarmento da Silva
Carvalho,Vanessa Henriques
Junqueira,Fernando Eduardo Feres
spellingShingle Santos,Filipe Nadir Caparica
Braga,Angelica de Fátima de Assunção
Ribeiro,Carla Josefine Barbosa de Lima
Braga,Franklin Sarmento da Silva
Carvalho,Vanessa Henriques
Junqueira,Fernando Eduardo Feres
Use of protocol and evaluation of postoperative residual curarization incidence in the absence of intraoperative acceleromyography - Randomized clinical trial
author_facet Santos,Filipe Nadir Caparica
Braga,Angelica de Fátima de Assunção
Ribeiro,Carla Josefine Barbosa de Lima
Braga,Franklin Sarmento da Silva
Carvalho,Vanessa Henriques
Junqueira,Fernando Eduardo Feres
author_sort Santos,Filipe Nadir Caparica
title Use of protocol and evaluation of postoperative residual curarization incidence in the absence of intraoperative acceleromyography - Randomized clinical trial
title_short Use of protocol and evaluation of postoperative residual curarization incidence in the absence of intraoperative acceleromyography - Randomized clinical trial
title_full Use of protocol and evaluation of postoperative residual curarization incidence in the absence of intraoperative acceleromyography - Randomized clinical trial
title_fullStr Use of protocol and evaluation of postoperative residual curarization incidence in the absence of intraoperative acceleromyography - Randomized clinical trial
title_full_unstemmed Use of protocol and evaluation of postoperative residual curarization incidence in the absence of intraoperative acceleromyography - Randomized clinical trial
title_sort use of protocol and evaluation of postoperative residual curarization incidence in the absence of intraoperative acceleromyography - randomized clinical trial
description Abstract Objective Evaluate the incidence of postoperative residual curarization (PORC) in the post-anesthesia care unit (PACU) after the use of protocol and absence of intraoperative acceleromyography (AMG). Methods Randomized clinical trial with 122 patients allocated into two groups (protocol and control). Protocol group received initial and additional doses of rocuronium (0.6 mg·kg-1 and 10 mg, respectively); the use of rocuronium was avoided in the final 45 min; blockade reversal with neostigmine (50 µg·kg-1); time ≥15 min between reversion and extubation. Control: initial and additional doses of rocuronium, blockade reversal, neostigmine dose, and extubation time, all at the discretion of the anesthesiologist. AMG was used in the PACU and PORC considered at T4/T1 ratio <1.0. Results The incidence of PORC was lower in protocol group than in control group (25% vs. 45.2%, p = 0.02). In control group, total dose of rocuronium was higher in patients with PORC than without PORC (0.43 vs. 0.35 mg·kg-1·h-1, p = 0.03) and the time interval between the last administration of rocuronium and neostigmine was lower (75.0 vs. 101.0 min, p < 0.01). In protocol group, there was no difference regarding the analyzed parameters (with PORC vs. without PORC). Considering the entire study population and the presence or absence of PORC, total dose of rocuronium was higher in patients with PORC (0.42 vs. 0.31 mg·kg-1·h-1, p = 0.01), while the time interval between the last administration of rocuronium and neostigmine was lower (72.5 vs. 99.0 min, p ≤ 0.01). Conclusion The proposed systematization reduced PORC incidence in PACU in the absence of intraoperative AMG.
publisher Sociedade Brasileira de Anestesiologia
publishDate 2017
url http://old.scielo.br/scielo.php?script=sci_arttext&pid=S0034-70942017000600592
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