Brazilian Journal of Anesthesiology
https://app.periodikos.com.br/journal/rba/article/doi/10.1590/S0034-70942011000200004
Brazilian Journal of Anesthesiology
Artigo Científico

Avaliação do bloqueio neuromuscular em crianças no momento da reversão do bloqueio e da retirada da cânula endotraqueal

Assessment of neuromuscular blockade in children at the time of block reversal and the removal of the endotracheal tube

Camila Machado de Souza; Fernanda Elizabeth Romero; Maria Angela Tardelli

http://dx.doi.org/10.1590/S0034-70942011000200004 Braz J Anesthesiol, vol.61, n2, p.150-155, 2011
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Resumo

JUSTIFICATIVA E OBJETIVOS: Estudos evidenciam a importância da monitoração da função neuromuscular na prevenção do bloqueio residual. No entanto, a maioria dos anestesistas em sua prática diária se abaliza em dados clínicos para avaliar a recuperação da função neuromuscular. O objetivo deste estudo foi avaliar o grau de bloqueio neuromuscular em crianças submetidas à anestesia geral no momento da reversão do bloqueio e da retirada da cânula endotraqueal. MÉTODO: Foram avaliadas crianças entre 3 meses e 12 anos, submetidas à anestesia geral com uso de atracúrio ou rocurônio. A monitoração foi iniciada no momento da reversão do bloqueio neuromuscular e/ou retirada da cânula endotraqueal. O anestesiologista não era informado sobre o valor de T4/T1; apenas era alertado quando o momento era inadequado para a retirada da cânula endotraqueal. Houve registro do grau de bloqueio neuromuscular desde o início da monitoração, bem como do intervalo para a recuperação da relação T4/T1 > 0,9, doses de bloqueador e neostigmina utilizadas, fração expirada do agente inalatório, duração da anestesia, temperatura central e periférica. RESULTADOS: O bloqueio neuromuscular foi revertido em 80% das crianças no Grupo Rocurônio e 64,5% no Grupo Atracúrio. A reversão foi incorreta em 45,8 % do Grupo Rocurônio e 25% do Grupo Atracúrio. A incidência de T4/T1 < 0,9 no momento da retirada da cânula endotraqueal foi de 10% em ambos os grupos. CONCLUSÕES: Na decisão de retirada da cânula endotraqueal, com base em critérios clínicos, 10% das crianças apresentavam T4/T1 < 0,9, independentemente do bloqueador recebido. Um número considerável de pacientes teve o bloqueio neuromuscular revertido de maneira incorreta, quando o bloqueio ainda era profundo demais ou mesmo já estava recuperado.

Palavras-chave

ANESTESIA, Geral, BLOQUEADORES NEUROMUSCULARES, CIRURGIA, Pediátrica, INTUBAÇÃO TRAQUEAL, MONITORIZAÇÃO

Abstract

BACKGROUND AND OBJECTIVES: Studies show the importance of monitoring neuromuscular function in preventing the residual block. However, most anesthesiologists in their daily practice base their evaluation of the recovery of neuromuscular function on clinical data. The aim of this study was to assess the degree of neuromuscular blockade in children undergoing general anesthesia at the time of block reversal and the removal of the endotracheal tube. METHOD: We evaluated children between 3 months and 12 years of age undergoing general anesthesia with the use of atracurium or rocuronium. Monitoring was initiated at the time of reversal of neuromuscular blockade and/or removal of the endotracheal tube. The anesthesiologist was not informed about the T4/T1 value; he/she was only alerted when the time was inadequate for the removal of the endotracheal tube. Since the start of the monitoring process, the degree of neuromuscular blockade was registered, as well as the interval of recovery of the T4/T1 > 0,9 ratio, the doses of neostigmine and blocker used, the expired fraction of the inhalational agent, the duration of the anesthesia, and core and peripheral temperatures. RESULTS: Neuromuscular blockade was reversed in 80% of the children of the Rocuronium Group and in 64.5% of the Atracurium Group. The reversal was incorrect in 45.8% of the Rocuronium Group and in 25% of the Atracurium Group. The incidence of T4/T1 < 0.9 at the time of the removal of the endotracheal tube was 10% in both groups. CONCLUSIONS: When deciding to remove the endotracheal tube based on clinical criteria, 10% of children had T4/T1 < 0.9 regardless the blocker received. A considerable number of patients had the neuromuscular blockade incorrectly reversed when the blockade was still too deep or even already recovered.

Keywords

Neuromuscular Blocking Agents, Atracurium, Androstanols, rocuronium, Anesthesia, General, Infant, Child, Child, Preschool

Referências

Kopman AF, Eikermann M. Antagonism of non-despolarising neuromuscular block: current practice. Anaesthesia. 2009;64(^s1):22-30.

Beaussier M, Boughaba MA. Curarisation résiduelle. Ann Fr Anesth Reanim. 2005;24:1266-1274.

Murphy GS. Residual neuromuscular blockade: incidence, assessment, and relevance in the postoperative period. Minerva Anestesiol. 2006;72:97-109.

Eikermann M, Gerwig M, Hasselmann C. Impaired neuromuscular transmission after recovery of the train-of-four ratio. Acta Anaesthesiol Scand. 2007;51:226-234.

Eikermann M, Fassbender P, Malhotra A. Unwarranted administration of acetylcholinesterase inhibitors can impair genioglossus and diaphragm muscle function. Anesthesiology. 2007;107:621-629.

Viby-Mogensen J, Chraemmer JB, Ording H. Residual curarization in the recovery room. Anesthesiology. 1979;50:539-541.

Kopman AF, Kopman DJ, Ng J. Antagonism of profound cisatracurium and rocuronium block: the role of objective assessment of neuromuscular function. J Clin Anesth. 2005;17:30-35.

Kopman AF. Neuromuscular blocking agents: new insights and old controversies. Sem Anesth Perioperat Med Pain. 2002;21:75-85.

Bevan JC, Collins L, Fowler C. Early and late reversal of rocuronium and vecuronium with neostigmine in adults and children. Anesth Analg. 1999;89:333-339.

Meretoja OA, Gebert R. Postoperative neuromuscular block following atracurium or alcuronium in children. Can J Anaesth. 1990;37:743-746.

Sorgenfrei IF, Viby-Mogensen J, Swiatek SA. Fører evidens til ændret klinisk praksis?: Danske anæstesilaegers og anæstesiplejerskers kliniske praksis og viden om postoperativ restkurarisering. Ugeskr Læger. 2005;167:3878-3882.

Almeida MCS. O uso de bloqueadores neuromusculares no Brasil. Rev Bras Anestesiol. 2004;54:850-864.

Saldien V, Vermeyen KM. Neuromuscular transmission monitoring in children. Pediatr Anesth. 2004;14:289-292.

Meretoja OA, Wirtavuori K. Influence of age on the dose-response relationship of atracurium in paediatric patients. Acta Anaesthesiol Scand. 1988;32:614-618.

Rapp HJ, Altenmueller CA, Waschke C. Neuromuscular recovery following rocuronium bromide single dose in infants. Pediatr Anesth. 2004;14:329-335.

Reid JE, Breslin DS, Mirakhur RK. Neostigmine antagonism of rocuronium block during anesthesia with sevoflurane, isoflurane or propofol. Can J Anesth. 2001;48:351-355.

Brull SJ, Ehrenwerth J, Silverman DG. Stimulation with submaximal current for train-of-four monitoring. Anesthesiology. 1990;72:629-632.

Bevan DR, Kahwaji R, Ansermino JM. Residual block after mivacurium with or without edrophonium reversal in adults and children. Anesthesiology. 1996;84:362-367.

Brandom BW, Woelfel SK, Cook DR. Clinical pharmacology of atracurium in infants. Anesth Analg. 1984;63:309-312.

Baxter MRN, Bevan JC, Samuel JMB. Postoperative neuromuscular function in pediatric day-care patients. Anesth Analg. 1991;72:504-508.

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