Feasibility of full and rapid neuromuscular blockade recovery with sugammadex in myasthenia gravis patients undergoing surgery - a series of 117 cases.
Feasibility of full and rapid neuromuscular blockade recovery with sugammadex in myasthenia gravis patients undergoing surgery - a series of 117 cases.
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DOI：
10.2147/tcrm.s93009
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发表时间：
2015
影响因子：
2.8
通讯作者：
Lischke R
中科院分区：
文献类型：
--
作者：
Vymazal T;Krecmerova M;Bicek V;Lischke R
重症肌无力（MG）是一种干扰神经肌肉传递的自身免疫性疾病。如果使用非去极化肌松药，患者有术后残余curarization（PORC）的风险。临床上不明显的肌力不足可能导致通气不足和术后支气管扩张。我们描述了一个117例患者的队列，其中sugammadex用于接受罗库溴铵肌松手术的MG患者。我们使用罗库溴铵和sugammadex作为肌松拮抗剂麻醉了117例MG患者。105例患者接受了胸腺切除术，12例患者接受了胆囊切除术（5例剖腹手术，7例腹腔镜手术）。我们使用TOF-Watch®测量了从sugammadex给药到恢复和拔管的时间（连续四个电脉冲[四串] >0.9）。我们追踪了外周毛细血管血氧饱和度（SpO 2）<95%，二氧化碳分压（pCO 2）高于基线>10%，术后最初48小时内重新插管的次数，以及术后120小时内肺炎的次数。将结果处理为平均值、最小值和最大值。sugammadex给药后达到0.9的四个成串所需的时间平均为117秒（最短105秒/最长127秒），差异在<10%的偏差范围内。sugammadex给药后的拔管时间平均为276秒（最短251秒/最长305秒），不同患者之间的差异也很小。我们观察到所有117例患者术后SpO 2 <95%，pCO 2升高>10%，前48小时内无紧急重新插管，120小时内无临床诊断的肺炎。在这个使用罗库溴铵和sugammadex进行手术的MG患者队列中，我们没有观察到任何术后残留箭毒和呼吸抑制的迹象。肌松恢复可靠、可预测且迅速。
Myasthenia gravis (MG) is an autoimmune disease interfering with neuromuscular transmission. Patients are at risk of postoperative residual curarization (PORC) if nondepolarizing muscle relaxants are used. Clinically inapparent insufficient muscle strength may result in hypoventilation and postoperative bronchopneumonia. We describe a cohort of 117 cases in which sugammadex was used in MG patients undergoing surgery with muscle relaxation with rocuronium. We anesthetized 117 patients with MG using rocuronium and sugammadex as neuromuscular blockade reversal agent. One hundred five patients underwent surgical thymectomy and 12 underwent cholecystectomy (five laparotomic and seven laparoscopic). We measured time from sugammadex administration to recovery and to extubation, using the TOF-Watch® (series of four consecutive electrical impulses [the train-of-four] >0.9). We tracked peripheral capillary oxygen saturation (SpO2) <95%, elevation of partial pressure of carbon dioxide (pCO2) >10% above baseline, number of reintubations within the first 48 hours, and number of pneumonias within 120 hours, postoperatively. Results were processed as average, minimum, and maximum values. The period needed to reach train-of-four of 0.9 following sugammadex administration was on average 117 seconds (minimum of 105 seconds/maximum of 127 seconds) and differed within deviation <10%. The time to extubation following sugammadex administration was on average 276 seconds (minimum of 251 seconds/maximum of 305 seconds) and differed minimally among patients as well. We observed no SpO2 <95%, no pCO2 elevation >10% above a baseline, no emergent reintubation within the first 48 hours, and no pneumonia diagnosed on clinical basis within 120 hours, postoperatively in all 117 patients. In this cohort of MG patients undergoing surgery using rocuronium and sugammadex, we did not observe any signs of postoperative residual curarization and respiratory depression. The neuromuscular blockade recovery was reliable, predictable, and rapid.