PDF(Pubmed)
Abstract：
OBJECTIVE: To determine the effect of tetanic stimulation on the time to achieve stabilization of the T1 height, by acceleromyography train-of-four (TOF) ratio monitoring, in patients aged 60 to 80 years.
METHODS: Randomized, prospective, single-blind, controlled trial in patients aged 60 to 80 years undergoing elective surgery under general anesthesia in two university hospitals in Brazil between December 2019 and March 2022. This trial was performed in accordance with the principles of the Helsinki Declaration and the guidelines for good clinical research practice in pharmacodynamic studies of neuromuscular blocking agents II. Participants were randomly allocated by computer-generated numbers to receive tetanic stimulation (intervention group, n = 25) or not receive tetanic stimulation (control group, n = 25) to achieve T1 height stabilization on TOF ratio monitoring. The primary endpoint was to evaluate the effect of tetanic stimulation on the time to achieve stabilization of the T1 height. We also evaluated the effect on the onset time of rocuronium and time to recover from neuromuscular blockade with a single dose of rocuronium 0.6 mg.kg-1 with spontaneous recovery.
RESULTS: There was no statistically significant difference between the groups in the time to T1 height stabilization (intervention: 4.3 [2.0-8.0] min; control: 5.8 [2.0-10.5] min; p = 0.202), onset time of the neuromuscular blocking agent (intervention: 1.9 [±0.7] min; control: 2.2 [±1.0] min; p = 0.219), or neuromuscular blockade recovery times to normalized TOF values of 0.7 (intervention: 106.1 [±37.2] min; control: 91.7 [±27.5] min; p = 0.295), 0.8 (intervention: 114.3 [±40.1] min; control: 97.8 [±28.9] min; p = 0.225), 0.9 (intervention: 126.5 [±44.0] min; control: 106.9 [±30.6] min; p = 0.153), and 1.0 (intervention: 138.3 [±43.4] min; control: 123.8 [±43.5] min; p = 0.425).
CONCLUSIONS: The results of this study suggest that the recommendation to use tetanic stimulation to shorten the time to T1 height stabilization in neuromuscular monitoring did not alter the stabilization time of the T1 twitch or the pharmacodynamics of neuromuscular blockade with rocuronium in patients aged 60 to 80 years.
METHODS: Randomized, prospective, single-blind, controlled trial in patients aged 60 to 80 years undergoing elective surgery under general anesthesia in two university hospitals in Brazil between December 2019 and March 2022. This trial was performed in accordance with the principles of the Helsinki Declaration and the guidelines for good clinical research practice in pharmacodynamic studies of neuromuscular blocking agents II. Participants were randomly allocated by computer-generated numbers to receive tetanic stimulation (intervention group, n = 25) or not receive tetanic stimulation (control group, n = 25) to achieve T1 height stabilization on TOF ratio monitoring. The primary endpoint was to evaluate the effect of tetanic stimulation on the time to achieve stabilization of the T1 height. We also evaluated the effect on the onset time of rocuronium and time to recover from neuromuscular blockade with a single dose of rocuronium 0.6 mg.kg-1 with spontaneous recovery.
RESULTS: There was no statistically significant difference between the groups in the time to T1 height stabilization (intervention: 4.3 [2.0-8.0] min; control: 5.8 [2.0-10.5] min; p = 0.202), onset time of the neuromuscular blocking agent (intervention: 1.9 [±0.7] min; control: 2.2 [±1.0] min; p = 0.219), or neuromuscular blockade recovery times to normalized TOF values of 0.7 (intervention: 106.1 [±37.2] min; control: 91.7 [±27.5] min; p = 0.295), 0.8 (intervention: 114.3 [±40.1] min; control: 97.8 [±28.9] min; p = 0.225), 0.9 (intervention: 126.5 [±44.0] min; control: 106.9 [±30.6] min; p = 0.153), and 1.0 (intervention: 138.3 [±43.4] min; control: 123.8 [±43.5] min; p = 0.425).
CONCLUSIONS: The results of this study suggest that the recommendation to use tetanic stimulation to shorten the time to T1 height stabilization in neuromuscular monitoring did not alter the stabilization time of the T1 twitch or the pharmacodynamics of neuromuscular blockade with rocuronium in patients aged 60 to 80 years.
摘要：
目的：为了确定强直刺激对达到T1高度稳定的时间的影响，通过加速肌电图四组(TOF)比率监测，60至80岁的患者。
方法：随机化，prospective,单盲,2019年12月至2022年3月在巴西两家大学医院接受全麻择期手术的60至80岁患者的对照试验。该试验是根据赫尔辛基宣言的原则和神经肌肉阻断剂II的药效学研究中良好的临床研究实践指南进行的。参与者通过计算机生成的数字随机分配接受强直刺激(干预组，n=25)或不接受强直刺激(对照组，n=25)以在TOF比率监测上实现T1高度稳定。主要终点是评估强直刺激对达到T1高度稳定的时间的影响。我们还评估了单剂量0.6mg罗库溴铵对罗库溴铵起效时间和神经肌肉阻滞恢复时间的影响。kg-1自发恢复。
结果：两组在达到T1身高稳定的时间上没有统计学上的显着差异（干预：4.3[2.0-8.0]分钟；对照组：5.8[2.0-10.5]分钟；p=0.202），神经肌肉阻滞剂的起效时间（干预：1.9[±0.7]分钟；对照：2.2[±1.0]分钟；p=0.219），或神经肌肉阻滞恢复时间至归一化TOF值为0.7（干预：106.1[±37.2]分钟；对照：91.7[±27.5]分钟；p=0.295），0.8（干预：114.3[±40.1]分钟；控制：97.8[±28.9]分钟；p=0.225），0.9（干预：126.5[±44.0]分钟；控制：106.9[±30.6]分钟；p=0.153），和1.0（干预：138.3[±43.4]分钟；对照：123.8[±43.5]分钟；p=0.425）。
结论：这项研究的结果表明，在神经肌肉监测中使用强直刺激来缩短T1高度稳定时间的建议并没有改变T1抽搐的稳定时间或罗库溴铵对60至80岁患者的神经肌肉阻滞的药效学。
方法：随机化，prospective,单盲,2019年12月至2022年3月在巴西两家大学医院接受全麻择期手术的60至80岁患者的对照试验。该试验是根据赫尔辛基宣言的原则和神经肌肉阻断剂II的药效学研究中良好的临床研究实践指南进行的。参与者通过计算机生成的数字随机分配接受强直刺激(干预组，n=25)或不接受强直刺激(对照组，n=25)以在TOF比率监测上实现T1高度稳定。主要终点是评估强直刺激对达到T1高度稳定的时间的影响。我们还评估了单剂量0.6mg罗库溴铵对罗库溴铵起效时间和神经肌肉阻滞恢复时间的影响。kg-1自发恢复。
结果：两组在达到T1身高稳定的时间上没有统计学上的显着差异（干预：4.3[2.0-8.0]分钟；对照组：5.8[2.0-10.5]分钟；p=0.202），神经肌肉阻滞剂的起效时间（干预：1.9[±0.7]分钟；对照：2.2[±1.0]分钟；p=0.219），或神经肌肉阻滞恢复时间至归一化TOF值为0.7（干预：106.1[±37.2]分钟；对照：91.7[±27.5]分钟；p=0.295），0.8（干预：114.3[±40.1]分钟；控制：97.8[±28.9]分钟；p=0.225），0.9（干预：126.5[±44.0]分钟；控制：106.9[±30.6]分钟；p=0.153），和1.0（干预：138.3[±43.4]分钟；对照：123.8[±43.5]分钟；p=0.425）。
结论：这项研究的结果表明，在神经肌肉监测中使用强直刺激来缩短T1高度稳定时间的建议并没有改变T1抽搐的稳定时间或罗库溴铵对60至80岁患者的神经肌肉阻滞的药效学。
