Nil KAAN, Özlem KOCATÜRK, İbrahim KURT, Halil ÇİÇEK, Emel MEMETOĞLU

TEK DOZ ORTA ETKİLİ KAS GEVŞETİCİLERE BAĞLI POSTOPERATİF REZİDÜEL NÖROMUSKÜLER BLOK İNSİDANSI VE ETKİ EDEN FAKTÖRLER

AMAÇ:Bu çalışmanın amacı sağlıklı, erişkin hastalarda endotrakeal entübasyon için uygulanan tek doz orta etkisüreli kas gevşeticilerine (atrakuryum, vekuronyum ve rokuronyum) bağlı erken postoperatif rezidüelnöromusküler blok (PRNB) insidansını ve buna etki eden sonra faktörleri araştırmaktır.GEREÇ ve YÖNTEM:Çalışma prospektif, gözlemsel olarak, anestezi sırasında sadece endotrakealentübasyonu kolaylaştırmak için tek doz vekuronyum, atrakuryum veya rokuronyum kullanılan ve ameliyatbittikten sonra derlenme odasına alınan hastalarda yapıldı. Derlenme odasında akselomiyograf ile nöromuskülerileti monitorize edildi ve dörtlü uyarıya yanıt (TOF) oranı ölçüldü; 0,9'un altındaki değerler “PRNB var” olarakkaydedildi. Hastalara kullanılan anestezikler ve kas gevşeticisinin seçimi, antidot (neostigmin) kullanımı,ekstübasyon ve derlenme odasına alınma kararları hastayı takip eden anestezi doktoruna bırakıldı. Yaş, kilo,cinsiyet, antidot kullanımı, anestezi süresi, ekstübasyondan sonra derlenme odasına alınma süreleri PRNB içinrisk faktörü olarak alındı, stepwise lojistik regresyon analizi yapıldı.BULGULAR:Çalışmaya 84 hasta alındı, vekuronyum, atrakuryum, rokuronyum kullanılan hasta sayısısırasıyla 29, 28, 27 oldu. Hastaların % 58,3'ne neostigmin yapıldı. Medyan anestezi süresi 80 dakikaydı.Derlenme odasında PRNB insidansı (TOF<0,90) % 13,1 bulundu. Regresyon analizinde cinsiyetin PRNB'uetkilediği; kadın cinsiyetin, PRNB riskini artırdığı bulundu (OR: 7,250, %95 CI:1,019-51,593). Diğer riskfaktörlerinin PRNB'a anlamlı etkisi saptanmadı.SONUÇ:Klinik olarak ameliyat nedeni dışında ek risk faktörü taşımayan ve anestezi süresi bir saatten uzun olanhastalarda, “cinsiyet” tek doz orta etkili kas gevşeticilerine bağlı PRNB insidansını etkileyebilir

Anahtar Kelimeler:

Nöromusküler blok, rezidüel paralizi, nöromusküler monitörizasyon, kas gevşeticisi, atrakuryum, vekuronyum, rokuronyum

The Incidence of Residual Neuromuscular Blockade Associated with Single Dose of Intermediate-acting Non-depolarizing Neuromuscular Blocking

PURPOSE: The goal of this study is to investigate the incidence of postoperative residual neuromuscular blockade (PRNB) associated with single-dose intermediate-acting muscle relaxants (atracurium, vecuronium, rocuronium) administered to adult patients for endotracheal intubation during early postoperative period and subsequent factors affecting this. MATERIALS and METHODS: This prospective and observational study was conducted after obtaining the permission of the local ethics committee. Adult, ASA I, II patients who received a single dose of vecuronium, atracurium or rocuronium 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 “PRNB present”. Age, weight, gender, reversal, anesthesia duration, time for transfer to the recovery room after extubation were considered risk factors for PRNB, stepwise logistic regression analysis was conducted. RESULTS: This study included 84 patients and the number of patients that were given vecuronium, atracurium, rocuronium were 29, 28, and 27, respectively. After the end of the operation, reversal was performed with neostigmine in 58.3% of the patients. The median length of anesthesia was 80 minutes. PRNB incidence (TOF<0.90) in the recovery room was determined to be 13.1%. Based on the regression analysis, gender was determined to affect PRNB; female gender increased PRNB risk (OR: 7.250, 95%, CI:1.019-51.593). The remaining factors did not have any significant effect on PRNB. CONCLUSION: In patients who do not have other risk factors in addition to the operation reason and whose anesthesia duration is longer than one hour, “gender” may affect PRNB incidence associated with single-dose intermediate-acting muscle relaxants.

Keywords:

Neuromuscular block, residual paralysis, neuromuscular monitoring, muscle relaxant, atracurium, vecuronium, rocuronium,

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