儿童残余神经肌肉阻滞的患病率和危险因素仍未明确。我们假设特定患者和麻醉危险因素可能与新斯的明罗库溴铵初始逆转后的儿童额外逆转有关。
我们的电子健康记录被查询为从2017年到2020年接受罗库溴铵和新斯的明逆转的年龄<18岁的患者。接受其他非去极化神经肌肉阻滞药物的患者被排除在外。感兴趣的结果被定义为在用新斯的明初次逆转后施用额外的新斯的明或Sugammadex。最后一次罗库溴铵和新斯的明初始剂量之间的时间,和罗库溴铵的累积剂量是二分法。这些与其他协变量相结合,包括年龄,体重,性别,种族群体,程序类型,ASA物理状态,>1剂量罗库溴铵在操作过程中给予,初始新斯的明剂量<0.05mgkg-1,使用四人组监控,麻醉持续时间,住院或门诊,紧急情况下,神经肌肉疾病,和极端的体重,评估与主要结局可能的关联。
在研究期间,101/6373(1.58%)患者接受了罗库溴铵和额外的逆转。最后一次剂量的罗库溴铵和新斯的明之间的时间二分法产生<28分钟,自上一次剂量的罗库溴铵和累积剂量>0.45mgkg-1hr-1。这些与OR为1.52(95%CI,1.08-2.35)和OR为1.71(95%CI,1.10-2.67)的额外逆转有关,分别。其他危险因素包括新斯的明初始剂量<0.05mgkg-1,或4.98(95%CI,2.84-6.49),和非洲裔美国人种族,OR1.78(95%CI,1.07-2.87)。
与额外逆转给药相关的危险因素包括从最后一次罗库溴铵到新斯的明初始剂量的时间<28分钟,罗库溴铵的累积剂量>0.45mgkg-1hr-1,初始新斯的明剂量<0.05mgkg-1,和非洲裔美国人种族。
The prevalence and risk factors for residual neuromuscular blockade in children remain poorly characterized. We hypothesize that specific patient and anesthetic risk factors may be associated with the administration of additional reversal in children following initial reversal of rocuronium with neostigmine.
Our electronic health record was queried for patients <18 years of age who received rocuronium and reversal with neostigmine from 2017 through 2020. Patients receiving other nondepolarizing neuromuscular blocking drugs were excluded. The outcome of interest was defined as the administration of additional neostigmine or sugammadex following primary reversal with neostigmine. Time between the last dose of rocuronium and initial dose of neostigmine, and the cumulative dose of rocuronium were dichotomized. These were combined with other covariates including age, weight, sex, racial group, procedure type, ASA physical status, >1 rocuronium dose administered during the procedure, initial neostigmine dose <0.05 mg kg-1 , use of train-of-four monitoring, duration of anesthesia, inpatient or outpatient, emergency
case, neuromuscular disease, and extremes of weight, to assess possible associations with the primary outcome.
During the study period, 101/6373 (1.58%) patients received rocuronium and additional reversal. Dichotomization of time between last dose of rocuronium and neostigmine yielded <28 min since the last dose of rocuronium and cumulative dose of rocuronium >0.45 mg kg-1 hr-1 . These were associated with the administration of additional reversal with an OR 1.52 (95% CI, 1.08-2.35) and OR 1.71 (95% CI, 1.10-2.67), respectively. Other risk factors included an initial neostigmine dose <0.05 mg kg-1 , OR 4.98 (95% CI, 2.84-6.49), and African American race, OR 1.78 (95% CI, 1.07-2.87).
Risk factors associated with the administration of additional reversal included time <28 min from the last dose of rocuronium to initial dose of neostigmine, cumulative dose of rocuronium >0.45 mg kg-1 hr-1 , initial neostigmine dose <0.05 mg kg-1 , and African American race.