RESUMO
INTRODUCTION: NMB facilitates intubating conditions in general anesthesia. However, it is associated with significant residual postoperative paralysis and morbidity. OBJECTIVE: To investigate the rate of underdiagnosed residual NMB based on two TOFR criteria (< 0.91 and < 1.00). METHODS: We performed a retrospective study adhering to STROBE guidelines. We included patients undergoing ENT surgery using single-dose neuromuscular block for balanced general anesthesia from June to December 2018. We collected demographic and anthropometric data, ASA score, NMBA dose, TOFR recordings at 5, 30 and 60 min and end of the surgery, anesthesia and surgery time, and administration of reversal agent. Statistical analysis included descriptive and dispersion measures statistics, curve and cross tables for residual NMB on different TOFR criteria with sub-analysis for AR, RR, and OR in patients over 65 years old. RESULTS: We included 57 patients, mean age 41; 43 females and 14 males. Mean anesthetic and surgical time were 139.4 and 116.1 min, respectively. All the patients received rocuronium under a mean ponderal single-dose of 0.48 mg/kg. Residual NMB rates were 29.9 and 49.1% for a TOFR < 0.91 and < 1.00, respectively. Older adults had an OR of 6.08 for residual NMB. CONCLUSIONS: The rate of residual NMB was 29.9 to 49.1%, depending on the criteria used (TOFR < 0.91 and < 1.00, respectively). Patients above 65 years old had an increased risk of residual NMB (6.08 OR) and clinical symptoms related to residual NMB (11.75 OR). We recommend future research aiming to provide a specific surveillance protocol for patients above 65 years old, including shorter-action NMB, early reversal, and prolonged surveillance using the TOFR criteria of < 1.00 to identify patients at risk of residual NMB readily.
Assuntos
Recuperação Demorada da Anestesia , Bloqueio Neuromuscular , Fármacos Neuromusculares não Despolarizantes , Masculino , Feminino , Humanos , Idoso , Adulto , Rocurônio , Estudos Retrospectivos , Recuperação Demorada da Anestesia/induzido quimicamente , Androstanóis , Bloqueio Neuromuscular/métodos , Anestesia Geral/métodosRESUMO
Resumen: El metoxiflurano es un anestésico halogenado que se utilizó hace varias décadas para anestesia general balanceada y que actualmente está indicado para otorgar sedación controlada por el paciente. Este medicamento se encuentra actualmente a la venta en la República Mexicana, por lo que recordar las características que lo hacen diferente a otros halogenados, su farmacocinética y su utilidad para distintos escenarios proporciona el conocimiento adecuado para su uso en la práctica clínica.
Abstract: Methoxyflurane is a halogenated anesthetic that was used decades ago for a balanced general anesthesia and is currently indicated for patient-controlled sedation. This drug is currently on sale in the Mexican Republic, so remembering the characteristics that make it different from other halogenated drugs, its pharmacokinetics and its usefulness for different scenarios provides knowledge for use in clinical practice.
RESUMO
Resumen: Las dianas terapéuticas para el control en el dolor postoperatorio son cada vez más conocidas. Entre ellas se encuentran las implicadas en canales de voltaje, iónicos, transportadores, ligadas a proteínas G, de reconocimiento molecular, peptídicos, neutróficos, enzimáticos, citoquínicos, celular, epigenético y genético. Además, podemos dividir a las dianas terapéuticas en tres grandes grupos dependiendo de su injerencia: las que actúan en el dolor agudo, aquéllos que irrumpirán en la generación de dolor crónico y los enfocados a la hiperalgesia. Claro está que casi todos están implicados en el mecanismo de los tres grupos de dolor, aunque infieren de manera más concisa en uno de ellos.
Abstract: The therapeutic targets for control in postoperative pain are increasingly well known. Among them are those involved in voltage, ion, transporter, G-protein, molecular recognition, peptide, neutrophic, enzymatic, cytokinic, cellular, epigenetic and genetic channels. We can also divide the therapeutic targets into three large groups depending on their interference; those that act in acute pain, those that will break into the chronic pain generation and those focused on hyperalgesia. Of course, almost everyone is involved in the mechanism of the three pain groups although they infer more concisely in one of them.
