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

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.

Incidence of Residual Neuromuscular Blocking in Oncological Patients in the Anesthetic Rescue Room: Importance of Objective Monitoring in the Foundation Center of Control of Oncology of the State of Amazonas - Fcecon

“…The inclusion criteria were: (1) Informed consent form signed by the patient; (2) Patients submitted to oncologic surgeries who used the neuromuscular blocker in orotracheal intubation and maintenance of junction, leading to the reduction of the acetylcholine degradation, potentializing its action. Such a method should be performed at the end of surgery and not before some degree of spontaneous blockade resolution has occurred [6]. Early administration of anticholinesterases may be ineffective due to the high rate of receptor uptake by NMBs.…”

“…An interval of 10 seconds should be expected between successive TOFs in order to avoid muscular fatigue during measurements. This response means that there is a rapid depletion of available acetylcholine stores, but it becomes slow to the point that it does not lead to muscular mobilization [6].…”

“…However, it is not sufficient to prevent aspiration of gastric contents. Value of T4/T1 > 0.8 represents the capacity of the patient to generate 90% of their tidal volume [6]. Values of the T4/T1 ratio below 0.9 evaluate worsening of the ventilatory response to hypoxia and the function of the pharyngeal and upper esophageal sphincter muscles, predisposing to pulmonary aspiration and ventilatory complications.…”

“…In the absence of such monitoring, the blockade should be routinely antagonized due to the unpredictability of its spontaneous recovery. However, the medications used for this purpose are not exempt from side effects, among them, the risk of oxygen desaturation at the beginning of the postoperative period is mentioned, which occurs due to the attempt to antagonize the deep block once that anticholinesterases are unable to reverse this level of BNM [1,6].…”