Barajas R, Camarena J, Castellanos A, Castilleros OA, Castorena G, De Anda D, Hernández M, López G, López V, Oliveros Y, Ramírez R, Rendón ME, Romo A, Velarde J, Yáñez J

Language: Spanish
References: 25
Page: 181-188
PDF size: 101.28 Kb.

ABSTRACT

Postanesthesic residual paralysis is called the clinical condition determined by the persistence of the pharmacological effects of nondepolarizing neuromuscular blocking agents after an anesthetic. Justification: Residual neuromuscular paralysis in postanesthetic care unit is a phenomenon that can increase postoperative morbidity, with an incidence varying between 0 and 93%. The impact of residual neuromuscular paralysis after surgery has been little studied, however, several studies suggest that the residual effects adversely affect respiratory function, impaired protective reflexes of the airways and cause unpleasant symptoms of muscular weakness. Objectives: The purpose of this study was to evaluate the incidence of residual neuromuscular paralysis in the postanesthetic care unit from different hospitals in Mexico. Methods: 822 patients were studied under general anesthesia with the use of cisatracurium, rocuronium, vecuronium or atracurium. After admission to the postanesthetic care unit was conducted to objectively monitor neuromuscular function with a peripheral nerve stimulator (TOF-Watch acceleromyography). Residual paralysis was defined (by international standards) to the presence of a TOF ratio ‹ 0.9, measured at the adductor pollicis of patients. Results: A total of 822 patients, 97 received cisatracurium, 356 rocuronium, 237 vecuronium, and 132 atracurium. The demographic characteristics and duration of the procedure were comparable in all groups. Making the sub-analysis within each group of neuromuscular blocking agents, the group of patients managed with atracurium showed an incidence of residual paralysis of 13%, cisatracurium 13%, vecuronium 19% and rocuronium 24%. Conclusions: Residual neuromuscular blockade was evidence when the patients arrive to the postanesthetic care unit, there is present a high incidence of residual blockade neuromuscular, independent from the agent neuromuscular used. The general incidence was of 19% of the patients, the group of patients who received atracurium and cisatracurium presented a minor incidence comparatively to the presented one for the agents’ family aminoesteroid. The residual paralysis constant posanesthetic being a problem that persists, so much for the blocking bencylisoquinoline, since for the aminoesteroid.

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