Veküronyum Kullanımında Görülen Rezidüel Kürarizasyon İnsidansı ve Yaş Gruplarının Buna Etkisi

Year 2014, Volume: 15 Issue: 2, 68 - 72, 01.08.2014

Özlem Kocatürk Meryem Nil Kaan İbrahim Kurt

Abstract

AMAÇ: Bu çalışmanın amacı sağlıklı, eriskin hastalarda vekuronyuma baglı erken ve geç derlenme dönemindeki postoperatif rezidüel kürarizasyon (RK) insidansını ve buna yaş gruplarının etkisini araştırmaktır.GEREÇ VE YÖNTEMLER: Çalısma prospektif, gözlemsel olarak, elektif cerrahilerde vekuronyum kullanılan ve ameliyat bittikten sonra derlenme odasına alınan hastalarda yapıldı. Derlenme odasında akselomiyograf ile nöromusküler ileti monitorize edildi ve dörtlü uyarıya yanıt (TOF) oranı ölçüldü; 0,9’un altındaki değerler “RK var” olarak kaydedildi. Hastalara kullanılan anestezikler ve kas gevseticisinin seçimi, antidot (neostigmin) kullanımı, ekstübasyon ve derlenme odasına alınma kararları hastayı takip eden anestezi doktoruna bırakıldı. Yaş RK için risk faktörü olarak alındı, binary lojistik regresyon analizi yapıldı.BULGULAR: Çalışmaya vekuronyum kullanılan 94 hasta alındı. Hastaların %52,1’ine neostigmin yapıldı. Ortalanma cerrahi süresi 96,5 dakikaydı. Derlenme odasında erken derlenme döneminde RK insidansı (TOF <0,90) %13,8 ve geç derlenme döneminde ise %5,3 olarak bulundu. Regresyon analizine göre yaş faktörünün, hem erken (OR: 0,714; %95 CI: 0,675-1,085) hem de geç (OR: 0,836; %95 CI: 0,226 - 3,185) derlenme döneminde, RK üzerine anlamlı etkisi saptanmadı. SONUÇ: Veküronyuma bağlı RK insidansı düşük oranda bulundu. Yaş faktörünün de sistemik sorunu olmayan hastalar için RK açısından risk faktörü olmadığı düşünüldü

Keywords

Rezidüel Kürarizasyon, nöromusküler monitörizasyon, vekuronyum, yaş, derlenme dönemi

The Incidence of Residual Curarization Associated with Vecuronium and the Effect of Age Groups

Abstract

OBJECTIVE: The aim of this study is to investigate the incidence of postoperative residual curarization (RC) associated with vecuronium administered to adult patients during early and late postoperative period and the effect of age groups. MATERIALS AND METHODS: This prospective and observational study was conducted after obtaining the permission of the local ethics committee. Adult patients who received vecuronium during general anesthesia for elective surgical procedure were included in the study. The decisions about the anesthetics and muscle relaxants used on the patients, reversal with neostigmine, extubation and transfer to the recovery room were left to be made by the anesthesiologist following the patient. The patient who was taken into the recovery room had neuromuscular monitoring using accelomyography. Train-of-four (TOF) ratios under 0.9 were recorded as “RC present”. Age was considered risk factor for RK, binary logistic regression analysis was conducted. RESULTS: This study included 94 patients were given vecuronium. Reversal was performed with neostigmine in 52.1% of the patients at the end of the operation. The median length of surgery was 96.5 minutes. RK incidence (TOF<0.90) in the recovery room was determined to be 13.1% (early recovery period) and 5.3% (late recovery period). Based on the regression analysis, the age factor did not have any significant effect onRC in the early (OR: 0.714; 95% CI: 0.675-1.085) and late (OR: 0.836; 95% CI: 0.226 - 3.185) recovery period. CONCLUSION: The incidence of RC following vecuronium is less frequent. It was shown to the age factor is not effect RC of vecuronium in early and late recovery period.

Keywords

Residual curarization, neuromuscular monitoring, vecuronium, age, recovery period

References

• 1. Murphy GS, Brull SJ. Residual neuromuscular block: Lessons unlearned. Part I: Definitions, incidence, and adverse physiologic effects of residual neuromuscular block. Anesth Analg 2010;111:120-8
• 2. Murphy GS. Residual neuromuscular blockade: incidence, assessment, and relevance in the postoperative period. Minevra Anestesiol 2006;72:97-109.
• 3. Murphy GS, Szokol JW, Marymont JH, Greenberg SB, Avram MJ, Vender JS. Residual neuromuscular blockade and critical respiratory events in the postanesthesia care unit. Anesth Analg 2008;107:130-7. [CrossRef]
• 4. Murphy GS, Szokol JW, Franklin M, Marymont JH, Avram MJ, Vender JS. Postanesthesia Care unit recovery times and neuromuscular blocking drugs: a prospective study of orthopedic surgical patients randomized to receive pancuronium or rocuronium. Anesth Analg 2004;98:193-200. [CrossRef]
• 5. Eikermann M, Groeben H, Hüsing J, Peters J. Accelerometry of adductor pollicis muscle predicts recovery of respiratory function from neuromuscular blockade. Anesth 2003;98:1333-7. [CrossRef]
• 6. Eriksson LI, Satoo M, Severinghaus JW. Effect of vecuronium induced partial neuromuscular block on hipoxic ventilatory response. Anesth 1993;78:693-9. [CrossRef]
• 7. Naguib M, Kopman AF, Ensor JE. Neuromuscular monitoring and postoperative residual curarisation: a meta-analysis. Br JAnaesth 2007;98:302-16. [CrossRef]
• 8. Baillard C, Clech C, Catineau J, Salhi F, Gehan G, Cupa M, et al. Postoperative residual neuromuscular block: a survey of management. Br J Anaesth 2005;95:622-6. [CrossRef]
• 9. Butterly A, Bittner EA, George E, Sandberg WS, Eikermann M, Schmidt U. Postoperative residual curarization from intermediate-acting neuromuscular blocking agents delays recovery room discharge. Br J Anaesth 2010;105:304-9. [CrossRef]
• 10. Baillard C, Gehan G, Marty RJ, Larmignat P, Samama CM, Cupa M. Residual curarization in the recovery room after vecuronium. Br J Anaesth 2000;84:394-5. [CrossRef]
• 11. Debaene B, Plaud B, Dilly MP, Donati F. Residual paralysis in the PACU after a single intubating dose of nondepolarizing muscle relaxant with an intermediate duration of action. Anesth 2003;98:1042-8. [CrossRef]
• 12. Murphy GS, Szokol JW, Franklin M, Marymont JH, Avram MJ, Vender JS. Postanesthesia Care unit recovery times and neuromuscular blocking drugs: a prospective study of orthopedic surgical patients randomized to receive pancuronium or rocuronium. Murphy Anesth Analg 2004;98:193-200. [CrossRef]
• 13. Claudius C, Karacan H, Viby-Mogensen J. Prolonged residual paralysis after a single intubating dose of rocuronium. Br J Anaesth 2007;213:1-4.
• 14. Hayes AH, Mirakhur RK, Breslin DS, Reid JE, McCourt KC. Postoperative residual block after intermediate-acting neuromuscular blocking drugs. Anesth 2001;56:312-8. [CrossRef]
• 15. Viby-Mogensen J. Postoperative residuel curarization and evidence– based anaesthesia. Br J Anaesth 2000;84:301-2. [CrossRef]
• 16. Naguib M. Pharmacology of muscle relaxant and their antagonist neuromuscular physiology and pharmacology. In: Miller RD ed. Anaesthesia. 6th ed. Philadelphia: Churchil Livingston; 2006. p.481-572.
• 17. Morgan GE, Mikhail MS, Murray MJ. Neuromuscular blocking agent. In: Morgan GE, Mikhail MS. Murray MJ eds. Clinical Anaesthesiology. Newyork, Lange Medical Books/McGraw-Hill Medical Publishing Division 2002.p.179-98.
• 18. Bissinger U, Schimek F, Lenz G. Postoperative residual paralysis and respiratory status: a comparative study of pancuronium and vecuronium. Physiol.Res 2000;49:455-62.
• 19. Eikermann M, Groeben H, Bunten B, Peters J. Fade of pulmoary function during residual neuromuscular blockade. Chest 2005;127:1703-9. [CrossRef]
• 20. Pino MR. Residual neuromuscular blockade: a persistent clinival problem. Int Anesthesiol Clin 2006;44:77-90. [CrossRef]