Use of reversal agents in day care procedures (with special reference to postoperative nausea and vomiting)
Use of reversal agents in day care procedures (with special reference to postoperative nausea and vomiting)
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DOI：
10.1046/j.1365-2346.2001.018s23053.x
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发表时间：
2001-01-01
影响因子：
3.6
通讯作者：
Mencke, T
中科院分区：
文献类型：
--
作者：
Fuchs-Buder, T;Mencke, T
关于残余麻痹的逆转对术后恶心和呕吐的发生的作用存在一些混淆。本综述的目的是讨论残余麻痹的拮抗作用是否是术后恶心和呕吐的原因，并评估如果忽略逆转作用，残余麻痹的风险。考虑了1998年之前发表的荟萃分析数据，沿着该日期之后发表的试验，以评估残余麻痹逆转对术后恶心和呕吐的影响，以及忽略拮抗作用时伤害的可能性。此外，还概述了残留麻痹的病理生理学后果、发生率和临床后果，并提出了神经肌肉恢复充分性的实际标准。当将所有试验和所有不同新斯的明剂量的呕吐结果结合起来时，省略新斯的明对术后恶心和呕吐没有有益的影响，但有一些证据表明新斯的明具有剂量反应性;更高的剂量可能具有催吐特性。然而，省略反转会引入非疏忽的残余瘫痪风险。对残留麻痹的病理后果（即喉和咽肌功能受损，低氧性痉挛控制改变，安全范围降低）的进一步理解导致建立了更严格的标准来定义神经肌肉恢复的充分性。现在，四个成串比率大于或等于0.9被认为是神经肌肉功能充分恢复的指标。应用这一新定义，残余瘫痪成为一种常见的不良副作用。因此，应定期监测非卧床患者的神经肌肉恢复情况，并通过逆转神经肌肉阻滞来预防残留麻痹。
There is some confusion about the contribution of reversal of residual paralysis to the occurrence of postoperative nausea and vomiting. The aim of this review is to discuss whether antagonism of residual paralysis is a cause of postoperative nausea and vomiting, and to assess the risk of residual paralysis if the reversal is omitted. Data from a meta-analysis published before 1998 were considered, along with trials published after that date to assess the influence of reversal of residual paralysis on postoperative nausea and vomiting, and the likelihood of harm when antagonism was omitted. Moreover, an overview of pathophysiological consequences, incidence and clinical consequences of residual paralysis is given and the actual criteria of the adequacy of neuromuscular recovery presented.When emetic outcomes are combined across all trials and all different neostigmine doses, there is no beneficial effect from omitting neostigmine on postoperative nausea and vomiting, but there is some evidence of a dose-responsiveness with neostigmine; higher doses may have emetic properties. However, omitting reversal introduces a non-negligent risk of residual paralysis. An improved understanding of the pathological consequences of residual paralysis (i.e.impaired laryngeal and pharyngeal muscle function, alterations in hypoxic ventilatory control, reduced margin of safety) led to establishment of more rigorous criteria for defining adequacy of neuromuscular recovery. A train-of-four ratio of greater than or equal to0.9 is now accepted as the index of adequate recovery of neuromuscular function. Applying this new definition, residual paralysis becomes a frequent adverse side-effect. Neuromuscular recovery should therefore be routinely monitored in ambulatory patients and residual paralysis prevented by reversing neuromuscular block.