Efficiency of the TOF-Cuff for the evaluation of rocuronium-induced neuromuscular block and its reversal with sugammadex: a comparative study vs. acceleromyography
Efficiency of the TOF-Cuff for the evaluation of rocuronium-induced neuromuscular block and its reversal with sugammadex: a comparative study vs. acceleromyography
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DOI：
10.1007/s00540-018-2587-4
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发表时间：
2019-02-01
影响因子：
2.8
通讯作者：
Suzuki, Takahiro
中科院分区：
文献类型：
--
作者：
Kameyama, Yasuhito;Takagi, Shunichi;Suzuki, Takahiro
目的本研究的目的是比较罗库溴铵诱导的神经肌肉阻滞和sugammadex拮抗后的TOF-Cuff（TOF-C）和TOF-Watch（TOF-W）数据。麻醉诱导后，用TOF-C和TOF-W同时评价罗库溴铵0.6mg/kg的肌松效应。评价强直后计数（PTC）和2 Hz四串（TOF）刺激后神经肌肉阻滞的起效时间和首次抽搐反应的持续时间。当两个监护仪都检测到对TOF刺激的反应时，给予额外剂量的罗库溴铵以维持神经肌肉阻滞。术后，当TOF-W观察到1-2次TOF抽搐时，给予2 mg/kg sugammadex，并评估促进恢复至TOF比>0.9所需的时间。结果回归分析显示，罗库诱导的神经肌肉阻滞的平均[SD]起效无统计学显著差异[127.8（27.2）秒，123.5（30.5）s]，至首次PTC抽搐恢复的时间[23.9（8.0）min，25.4（8.6）min]，TOF刺激下第一次抽搐恢复的时间[37.2（8.8）min，38.9（11.1）min]和sugammadex充分逆转的时间[139.2（30.6）s，151.8（31.5）s]。Bland-Altman分析也显示了可接受的范围内的偏差和限制的协议之间的两种methods.ConclusionsTOF-C可能是临床上适用于神经肌肉阻滞的深度和神经肌肉功能恢复的评价。
PurposeThe aim of this study was to compare TOF-Cuff (TOF-C) and TOF-Watch (TOF-W) data following rocuronium-induced neuromuscular block and its reversal with sugammadex.MethodsTwenty elderly patients aged 68-82years scheduled for surgery under general anesthesia were enrolled in this study. After induction of anesthesia, neuromuscular block resulting from administration of 0.6mg/kg rocuronium was concurrently evaluated using TOF-C and TOF-W. The onset of neuromuscular block and duration until the first twitch response following post-tetanic count (PTC) and 2Hz train-of-four (TOF) stimulation reappeared were evaluated. When the response to the TOF stimulus was detected with both monitors, additional doses of rocuronium were administered to maintain the neuromuscular block. After surgery, 2mg/kg sugammadex was administered when 1-2 TOF twitches were observed with the TOF-W and the time required for facilitated recovery to a TOF ratio of >0.9 was assessed.ResultsRegression analyses revealed no statistically significant differences in the mean [SD] onset of rocuronium-induced neuromuscular block [127.8 (27.2) s, 123.5 (30.5) s], time to recovery of the first PTC twitch [23.9 (8.0) min, 25.4 (8.6) min], time to recovery of the first twitch with TOF stimulation [37.2 (8.8) min, 38.9 (11.1) min] and time to adequate reversal with sugammadex [139.2 (30.6) s, 151.8 (31.5) s] between TOF-C and TOF-W, respectively. Bland-Altman analyses also showed acceptable ranges of the biases and limits of agreement between the two methods.ConclusionsTOF-C may be clinically applicable for the evaluation of both the depth of neuromuscular block and restoration of neuromuscular function.