METHODS: Data from three trials investigating deep NMB during laparoscopic surgery with total intravenous anesthesia (n = 424) were pooled to analyze the required rocuronium dose, when to start continuous infusion, and how to adjust. The resulting algorithm was validated (n = 32) and compared to the success rate in ongoing studies in which the algorithm was not used (n = 180).
RESULTS: The mean rocuronium dose based on actual bodyweight for PTC 1 to 2 was (mean ± SD) 1.0 ± 0.27 mg · kg-1 ·h-1 in the trials, in which mean duration of surgery was 116 min. An induction dose of 0.6 mg ·kg-1 led to a PTC of 1 to 5 in a quarter of patients after a mean of 11 min. The remaining patients were equally divided over too shallow (additional bolus and direct start of continuous infusion) or too deep; a 15-min wait after PTC of 0 for return of PTC to 1 or higher. Using the proposed algorithm, a mean 76% of all 5-min measurements throughout surgery were on target PTC 1 to 2 in the validation cohort. The algorithm performed significantly better than anesthesiology residents without the algorithm, even after a learning curve from 0 to 20 patients (42% on target, P ≤ 0.001, Cohen\'s d = 1.4 [95% CI, 0.9 to 1.8]) to 81 to 100 patients (61% on target, P ≤ 0.05, Cohen\'s d = 0.7 [95% CI, 0.1 to 1.2]).
CONCLUSIONS: This study proposes a dosing algorithm for deep NMB with rocuronium in patients receiving total intravenous anesthesia.
UNASSIGNED:
方法:汇集了三个研究腹腔镜手术期间使用TIVA(n=424)进行深NMB的试验数据,以分析所需的罗库溴铵剂量,何时开始连续输液以及如何调整。对所得算法进行了验证(n=32),并与未使用该算法的正在进行的研究中的成功率进行了比较(n=180)。
结果:对于PTC1-2,基于实际体重的平均罗库溴铵剂量为1.0±0.27mg。千克-1。在平均手术持续时间为±2小时(116分钟)的试验中,h-1。诱导剂量为0.6mg。kg-1在平均11分钟后,四分之一的患者的PTC为1-5。其余患者均分太浅(额外的推注和直接开始连续输注)或太深;PTC0后等待±15分钟,PTC恢复到≥1。使用所提出的算法,在验证队列中,整个手术5分钟测量结果的平均76%符合目标PTC1-2.该算法的性能明显优于没有该算法的麻醉住院医师,即使经过0-20名患者的学习曲线(42%的目标,P≤.001,Cohen\sd=1.4[95%CI0.9,1.8])至81-100名患者(61%的目标,P≤.05,科恩d=0.7[95%CI0.1,1.2])。
结论:我们提出了一种在接受TIVA的患者中使用罗库溴铵的深度NMB给药算法。