DOI: https://doi.org/10.22141/2224-0586.3.98.2019.165486

Monitoring of neuromuscular conduction and depth of anesthesia as the basis for general anesthesia management at different stages during abdominal surgery

K.R. Yakobchuk, O.V. Tkhorevskyi

Abstract


Background. The purpose of this study was to deve­lop algorithms for the safe control of deep anesthesia and neuromuscular conduction at the stage of rapid sequential induction and anesthesia recovery using instrumental monitoring me­thods of NMC. Materials and methods. The study included 30 patients. The patients were divided into two groups (the same number of patients in each group): the clinical methods and hardware methods (TOF-Watch SX apparatus in TOF stimulation mode) for monitoring the level of neuromuscular conduction were used in group 1 and 2, respectively. Group 1, without additional monitoring, presented with not only the slightest time from a muscle relaxant introduction to tracheal intubation (85.3 ± 4.9 seconds), but also worse conditions for intubation by the Cooper scale (7.8 ± 0.8, p < 0.05). And in group 2, there is a greater time from a muscle relaxant introduction to tracheal intubation compared with the control group (139.3 ± 4.5), as well as excellent conditions for intubation by the Cooper scale (8.9 ± 0.1 vs. 7.8 ± 0.8). Higher levels of mean blood pressure and heart rate in the first group at the stages of intubation and 5 minutes after intubation were associated with an inadequate level of anesthesia compared with the second group. Results. The time from the end of the operation to the extubation in the 1st group was 4.4 minutes (72 %) more than in the 2nd group. In addition, the time from the end of the surgery to transporting the patient to the ward in the 1st group was 6.6 minutes (62 %) more than in the 2nd group. Thus, the use of additional monitoring can reduce the time of a patient’s staying in the opera­ting room by 6.6 minutes. The consumption of rocuronium was significantly higher in the 1st group — 52.3 ± 1.0 mg, compared with the 2nd group — 42.3 ± 1.3 mg, that proves the significance of the difference compared with the control group (p < 0.05). Conclusions. The statistical results of our research have shown that TOF monitoring will help to conduct intubation under the most favorable conditions, provide adequate muscular rela­xation for mechanical ventilation and surgery procedure, timely extubation of the trachea, as well as to reduce the period of patients staying in the operating room.


Keywords


monitoring of neuromuscular conduction; neuromuscular block; TOF stimulation; myography; monitoring of muscular blockades

References


J. Bruhn, P.S. Myles, R. Sneyd and M.M. R.F. Struys. Depth of anaesthesia monitoring: what's availabla, what's validated and what's next?. Br. J. Anaesth. 2006. 97 (1): 85-94 doi:10.1093/bja/ael120.

Murphy G.S., Szokol J.W., Marymont J.H. et al. Residual neuromuscular blocade and critical respiratory events in tne postanesthesia care unit. Anesth Analg. 2008; 107 (1): 130 – 7. doi: 10.1213/ane.0b013e31816d1268

Grachev, S. S. Povyshenie bezopasnosti i effektivnosti primenenija myshechnih relaksantov pri anesteziologicheskom obespechenii intraabdominal'nih operativnih vmeshatel'stv : avtoref. dis. … kand. med. nauk : 14.01.20. S.S. Grachev ; BelMAPO. Minsk, 2011.22 с. http://dep.nlb.by/jspui/handle/nlb/39901

Morgan D. E., Mihail M.S. Klinicheskaja anesteziologija . Moskva, «Binom» S-30 Peterburg. 2000. 1 volume.

Winstead P.S., Fahy B,G., Guide to Neuromuscular Blocking Anents Anesthesiology News. July 2007. P.29-31.

Mizikov V.M., Rudenko M.V., Vereshhagina I.I., Lovcevich N.V. Cisatrakurium (Nimbeks): farmakokinetika, farmakodinamika i primenenie u vzroslih. Vestnik intensivnoj terapii. 1999. №3. С. 77-78. (in Russian).

Butrov A.V., Tehnologija ispol'zovanija miorelaksantov na osnove monitoringa nejro-myshechnoj provodimosti / A.V. Butrov, M.F. Drobyshev, V.E. Kislevich. M.: Izd-vo NCSSH im. A.N. Bakuleva RAMN, 2009. 48с. (in Russian).

Beecher G. H., Rozental P. Postoperative neuromuscular function. // Anaesth Intensive Care 2006; 14:41 -5;

Butrov A.V., Tehnologija ispol'zovanija miorelaksantov na osnove monitoringa nejro-myshechnoj provodimosti / A.V. Butrov, M.F. Drobyshev, V.E. Kislevich. M.: Izd-vo NCSSH im. A.N. Bakuleva RAMN, 2009. 48s. (in Russian).

Beecher H.K., Todd D.P. A study of the deaths with anesthesia and surgery: based on a study of 599, 548 anesthesias in ten institutions 1948-1952, inclusive. . Ann Surg 1954; 140:2-35

Viby-Mogensen J., Jorgensen B.C., Ording H. Residual curarization in the recovery room. Anesthesiology .1979; 50:539-41

Undetected Residual Neuromuscular Block Has Consequences.Aaron F. Kopman, M.D., retired. Anesthesiology 9 2008, Vol.109, 363-364. doi:10.1097/ALN.0b013e3181829ef8

A. V. Butrov, Tehnologija ispol'zovanija miorelaksantov na osnove monitoringa nejro-myshechnoj provodimosti. A. V. Butrov, M.F. Drobyshev, V. E. Kislevich. M.: Izd-vo NCSSH im. A.N. Bakuleva RAMN. 2009. 48s. (in Russian).

Anesthetic consideration for neuromuscular diseases. Katz, Jeffery A.; Murphy, Glenn S. Current Opinion in Anaesthesiology: June 2017. Volume 30. Issue 3 p 435–440

doi: 10.1097/ACO.0000000000000466

A. V. Butrov, Tehnologija ispol'zovanija miorelaksantov na osnove monitoringa nejro-myshechnoj provodimosti . A. V. Butrov, M.F. Drobyshev, V. E, Kislevich M. Izd-vo NCSSH im. A. N. Bakuleva RAMN. 2009. 48s. (in Russian).

Morgan D. E., Mihail M. S., Klinicheskaja anesteziologija. Moskva «Binom» S-30 Petergburg. 2000. 1 tom (in Russian).

Lekmanov A. U, Sravnitel'noe issledovanie dvuh vidov monitoringa nervno-myshechnoj funkcii – elektromiografii i akseleromiografii – vo vremja ansteziologicheskogo posobija u detej A. U. Lekmanov, S. G. Suvorov. Anesteziologija i reanimatologija. 2009. №4. С. 18-22. (in Russian).

Residual curarization in the recovery room after vecuronium. C Baillard G Gehan J Reboul-Marty P Larmignat C M Samama M Cupa.BJA: British Journal of Anaesthesia, Volume 84, Issue 3, 1 March 2000, Pages 394–395, https://doi.org/10.1093/oxfordjournals.bja.a013445

Hemmerling TM, Zaouter C. Neuromuscular blockade and outcome in cardiac anesthesia. Ann Card Anaesth [serial online] 2010 [cited 2019 Feb 25];13:189-91. Available from: http://www.annals.in/text.asp?2010/13/3/189/69035

Donati F., Antzaka C., Bevan D. R. Potency of pancuronium at the diaphragm and the addcuctor pollicis muscle in humans. Anesthesiology 2016; 65: 1-5 PMID:3729027




Copyright (c) 2019 EMERGENCY MEDICINE

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.

 

© Publishing House Zaslavsky, 1997-2019

 

   Seo анализ сайта