目的:神经肌肉阻滞剂(NMBAs)的Sugammadex逆转通常在术后进行。缺乏文献来探索Sugammadex用于神经外科患者的及时神经系统检查。NMBA,比如罗库溴铵,在插管期间在急诊科使用,其不可预测的作用持续时间通常会阻碍患者神经状态的及时准确评估。我们旨在探讨sugammadex在评估需要急性神经外科护理的患者中的作用。
方法:在我们的1级创伤中心对出现创伤性脑损伤或颅内出血的患者进行回顾性评估。感兴趣的患者是那些sugammadex逆转罗库溴铵神经肌肉阻滞的患者,从插管剂量,旨在确保及时的神经系统评估。9名患者被确定为GCS前/后sugammadex,罗库溴铵剂量,罗库溴铵给药和逆转之间的经过时间,并检索临床课程数据。
结果:到达GCS为5.2±3.2,插管在出现后10±2.5分钟内完成。罗库溴铵的剂量在患者之间是一致的,平均单剂量为1.2±0.3mg/kg。持续的神经肌肉阻滞范围为28至132分钟(87.3±34.3分钟)。所有患者在初始神经外科评估时表现出3T的GCS,在逆转之前。逆转后GCS升至6.0T±2.2。Sugammadex促进了9名患者中的8名更准确的临床决策,包括预防不必要的侵入性程序。9名患者中有2名最终出院或康复机构。
结论:罗库溴铵神经肌肉阻滞可以超出药代动力学预测,从而延迟及时和精确的神经评估。我们的数据表明,sugammadex可能是临床医生在神经外科人群中进行急性神经系统评估的有用补充。Sugammadex可能会影响某些患者的临床决策,并允许家庭和医生做出更明智的决策。需要前瞻性研究来明确评估sugammadex对急性神经外科手术结局的影响。
OBJECTIVE: Sugammadex reversal of neuromuscular blocking agents (NMBAs) is usually performed postoperatively. A scarcity of literature exists exploring sugammadex use for timely neurological examination of neurosurgical patients. NMBAs, like
rocuronium, are used in the Emergency Department during intubation and their unpredictable duration of action often impedes timely and accurate assessment of patient neurological status. We aim to explore the role of sugammadex in evaluating patients in need of acute neurosurgical care.
METHODS: Retrospective assessment of patients presenting with traumatic brain injury or intracranial hemorrhage was conducted at our level 1 trauma center. Patients of interest were those for whom sugammadex reversal of
rocuronium neuromuscular blockade, from intubating doses, was pursued to ensure timely neurologic assessment. Nine patients were identified for whom GCS pre-/post-sugammadex,
rocuronium dosing, elapsed time between
rocuronium administration and reversal, and clinical course data were retrieved.
RESULTS: Arrival GCS was 5.2 ± 3.2, with intubation accomplished within 10 ± 2.5 min of presentation.
Rocuronium dosing was consistent between patients, average single dose of 1.2 ± 0.3 mg/kg. Lingering neuromuscular blockade ranged from 28 to 132 min (87.3 ± 34.3 min). All patients exhibited a GCS of 3 T upon initial neurosurgical evaluation, prior to reversal. Post-reversal GCS rose to 6.0 T ± 2.2. Sugammadex facilitated more accurate clinical decision making in 8 of 9 patients, including prevention of unnecessary invasive procedures. Two of 9 patients were eventually discharged home or to a rehabilitation facility.
CONCLUSIONS: Rocuronium neuromuscular blockade can linger beyond pharmacokinetic predictions, thus delaying timely and precise neurologic assessment. Our data suggests sugammadex may be a useful addition to the clinician\'s armamentarium for acute neurologic assessment in the neurosurgical population. Sugammadex may impact clinical decision-making in certain patients and allow for more informed decision-making by families and physicians alike. Prospective studies are needed to definitively assess the impact of sugammadex on outcomes in acute neurosurgical settings.