| Encuesta de manejo actual de los relajantes neuromusculares en Estados Unidos y Europa |
A survey of current management of neuromuscular block in the United States and Europe. Naguib M, Kopman AF, Lien CA, Hunter JM, Lopez A, Brull SJ. Department of General Anesthesiology, Institute of Anesthesiology, Cleveland Clinic, 9500 Euclid Ave. - E-31, Cleveland, OH 44195, USA. naguibm@ccf.orgAnesth Analg. 2010 Jul;111(1):110-9. Epub 2009 Nov 12.Abstract BACKGROUND: Postoperative residual neuromuscular block is a frequent occurrence. Recent surveys of clinical practice in Europe suggest that neuromuscular blocking drugs are often administered without appropriate monitoring. No comparable survey has been undertaken in the United States (US). From this survey, we compared current clinical neuromuscular practice and attitudes between anesthesia practitioners in the US and Europe. METHODS: We conducted an Internet-based survey among anesthesia practitioners in the US and Europe. The Anesthesia Patient Safety Foundation and the European Society of Anaesthesiology e-mailed all of their active members, inviting them to anonymously answer a series of questions on a dedicated Internet Protocol address-sensitive website. The survey was available online for 60 days. The chi(2) test and Fisher's exact test were used to compare clinical survey items between the 2 cohorts. RESULTS: A total of 2636 completed surveys were received. Most respondents from the US (64.1%) and Europe (52.2%) estimated the incidence of clinically significant postoperative residual neuromuscular weakness to be <1% (P < 0.0001). Routine pharmacologic reversal was less common in Europe than in the US (18% vs 34.2%, respectively; P < 0.0001), and quantitative monitors were available to fewer clinicians in the US (22.7%) than in Europe (70.2%) (P < 0.0001). However, 19.3% of Europeans and 9.4% of Americans never use neuromuscular monitors. Most respondents reported that neither conventional nerve stimulators nor quantitative train-of-four monitors should be part of minimum monitoring standards. CONCLUSIONS: Our results suggest a lack of agreement among anesthesia providers about the best way to monitor neuromuscular function. Efforts to improve awareness by developing formal training programs and/or publishing official guidelines on best practices to reduce the incidence of postoperative neuromuscular weakness and patient morbidity are warranted http://www.anesthesia-analgesia.org/content/111/1/110.full.pdf+html |
| Monitoreo del bloqueo neuromuscular con el trazo del pulso oxímetro: una modificación sencilla de los principios de la mecanomiografía y de la aceleromiografía |
|
|
| Cuenta de tren de cuatro en el músculo corrugador superficial refleja mejor la relajación de los músculos abdominales que el aductor del pulgar |
TOF count at corrugator supercilii reflects abdominal muscles relaxation better than at adductor pollicis.
Kirov K, Motamed C, Ndoko SK, Dhonneur G.
Anaesthesia and Intensive Care Department, Jean Verdier University Hospital of Paris, 93143 Bondy Cedex, France.
Br J Anaesth. 2007 May;98(5):611-4. Epub 2007 Mar 23.
Abstract
BACKGROUND: A recovery profile from neuromuscular block similar to that of abdominal (AB) muscles, but different to that of the adductor pollicis (AP) muscle, has been demonstrated at the corrugator supercilii (CSC) muscle. We hypothesized that neuromuscular transmission (NMT) monitoring of CSC might provide useful information on AB relaxation compared with AP. We compared the visual estimation of NMT at CSC and AP with electromyographic measurements of AB during recovery from a vecuronium block. METHODS: Ten adult patients were studied during balanced anaesthesia. After induction of anaesthesia and tracheal intubation without neuromuscular blocking agents, supramaximal stimulations were applied to three nerves: left 10th intercostal, ulnar, and facial. Electromyographic activity (EMG) of AB was measured (ABemg). After a bolus dose of vecuronium 0.1 mg kg-1, an independent observer blinded to the EMG measurements counted visually detectable train-of-four (TOF) responses at CSC and AP. Values of ABemg associated with 1 to 4 TOF responses at CSC and AP were compared. Values are means (sd). RESULTS: Reappearance of the first and second TOF responses at CSC occurred significantly (P<0.05) earlier and at lower ABemg recovery than that of AP [35 (8) and 41 (9) min vs 51 (10) and 56 (12) min; and 17 (8) and 26 (9)% vs 56 (10) and 75 (11)%, respectively]. CONCLUSIONS: We demonstrated that the TOF response count at the CSC, compared with the AP, allowed a better quantification of the degree of AB muscle relaxation during recovery from vecuronium block.
http://bja.oxfordjournals.org/content/98/5/611.full.pdf+html |
|
No hay comentarios:
Publicar un comentario