RESUMO
BACKGROUND: To avoid postoperative residual neuromuscular block there is a need for a change in clinician's attitude towards monitoring and reversal. This study aims to evaluate changes of perioperative neuromuscular block management during the last decade in our institution and to quantify the incidence of postoperative residual neuromuscular block. METHODS: Patients receiving intermediate-acting neuromuscular blocking agents for scheduled surgical procedures during 3-month periods in 1995 (n=435), 2000 (n=130), 2002 (n=101), and in 2004 (n=218) were prospectively and successively enrolled in our study. The management of neuromuscular block in the operating room and the adequacy of the recovery were at the discretion of the anaesthesiologist. An attempt was made between each study period to promote a change in the management of neuromuscular block. In the post-anaesthesia care unit, train-of-four (TOF) stimulations were used to assess the presence of a residual neuromuscular block. RESULTS: Between 1995 and 2004 quantitative measurement and reversal of neuromuscular block in the operating room increased from 2 to 60% and from 6 to 42%, respectively (P<0.001). During the same time, the incidence of residual neuromuscular block defined as a TOF ratio less than 0.9 decreased from 62 to 3% (P<0.001). Use of objective neuromuscular monitoring and/or anticholinesterase drugs was less likely in patients with an inadequate recovery (P<0.001). CONCLUSIONS: During the last decade the incidence of residual neuromuscular block strongly decreased in our institution. It confirms the positive impact of neuromuscular monitoring and reversal of neuromuscular block in routine anaesthetic practice.
Assuntos
Bloqueadores Neuromusculares/farmacologia , Junção Neuromuscular/efeitos dos fármacos , Complicações Pós-Operatórias/prevenção & controle , Adulto , Idoso , Período de Recuperação da Anestesia , Atitude do Pessoal de Saúde , Monitoramento de Medicamentos/estatística & dados numéricos , Estimulação Elétrica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Monitorização Intraoperatória/estatística & dados numéricos , Bloqueio Neuromuscular/métodos , Bloqueadores Neuromusculares/antagonistas & inibidores , Junção Neuromuscular/fisiologia , Prática Profissional/tendênciasRESUMO
A simple process for fast fabrication of thin films with biomimetic morphological structures from a group of linear homopolymers is developed. Natural evaporation of tetrahydrofuran, chloroform, and hexane-dichloromethane solutions of poly(phenylacetylene)s that contain amino acid and ethylene glycol moieties under ambient conditions instantly produces three-dimensional porous films with structural patterns reminiscent of honeycombs and radiolarian shells. Morphological analysis by optical and electronic microscopy suggests that vesicles of the amphiphilic polymers serve as building blocks in the self-organization to the biomimetic structures.
