Abstract：
BACKGROUND: The number of trials investigating the effects of deep neuromuscular blockade (NMB) on surgical conditions and patient outcomes is steadily increasing. Consensus on which surgical procedures benefit from deep NMB (a posttetanic count [PTC] of 1 to 2) and how to implement it has not been reached. The European Society of Anaesthesiology and Intensive Care does not advise routine application but recommends use of deep NMB to improve surgical conditions on indication. This study investigates the optimal dosing strategy to reach and maintain adequate deep NMB during total intravenous anesthesia.
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:
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:
摘要：
背景：研究深层神经肌肉阻滞（NMB）对手术条件和患者预后的影响的试验数量正在稳步增加。尚未就哪些外科手术程序受益于深度NMB（破伤风后计数为1-2）以及如何实施该手术达成共识。ESAIC不建议常规应用，但建议使用深度NMB来改善适应证的手术条件。这项研究调查了在全静脉麻醉期间达到和保持足够深NMB的最佳给药策略。
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。
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。
