Objective:To observe the occurrence of residual neuromuscular blockade (RNMB) in post anesthesia care unit (PACU) in patients undergoing selective laryngeal surgery under general anesthesia and provide reference for improving the safety of muscle relaxants during the perioperative period.Methods:The adult patients who underwent laryngeal surgery in Beijing Tongren Hospital, Capital Medical University from July 2020 to March 2021 were collected. According to the muscle relaxants used in the surgery, the patients were divided into rocuronium bromide group, mivacurium chloride group, and cisatracurium group. The general information of patients in the different groups [age, body mass index, American Society of Anesthesiologists (ASA) classification, etc.], duration of surgery, anesthesia time, stay time in PACU, and recovery of neuromuscular function (expressed using train of four ratio, abbreviated as TOFr) were recorded and analyzed. The ability to speak and raise one′s head in PACU, as well as the occurrence of adverse events such as gastroesophageal reflux, aspiration, and dyspnea were also recorded.Results:A total of 320 patients were enrolled in the study, including 188 males (58.8%) and 132 females (41.2%), with a mean age of (50±13) years. The duration of surgery was (38.6±30.1) minutes, anesthesia time was (57.2±32.8) minutes, and stay time in PACU was (34.6±11.4) minutes. There were 115, 141, and 64 patients in the rocuronium bromide, mivacurium chloride, and cisatracurium groups, respectively. The differences in age, body mass index, and ASA grade in patients among the 3 groups were not significant (all P>0.05). The anesthesia time and duration of surgery in patients of the mivacurium chloride group were shorter than those of the rocuronium bromide and cisatracurium groups [(43.53±23.90) minutes vs. (67.54±37.72) minutes and (68.84±29.34) minutes; (26.87±22.18) minutes vs. (47.16±34.83) minutes and (48.84±27.57) minutes], and the differences were statistically significant (all P<0.01). The difference in stay time in PACU among the 3 groups was not statistically significant ( P>0.05). At the moment of entering PACU, 272 (88.6%) of 320 patients had TOFr<0.9, of which 105 (32.8%) had TOFr<0.7; when leaving PACU, the TOFr of all patients was>0.9. Except the time point of leaving PACU, TOFr in the rocuronium bromide group at the other time points were higher than those in the cisatracurium group (all P<0.01). Except the 2 time points of the moment of entering and leaving PACU, TOFr in the mivacurium chloride group was higher than those in the cisatracurium group (all P<0.01). At the moment of entering PACU and 5 minutes after entering PACU, TOFr in the mivacurium chloride group was lower than those in the rocuronium bromide group (all P<0.05). When entering PACU, 79 of 320 patients had saturation of pulse oximetry (SpO 2)<0.95 and the difference in SpO 2 among the 3 groups was statistically significant ( P=0.029), of which 4 cases (6.25%) had SpO 2<0.90 in the cisatracurium group, and the incidence of hypoxemia was higher than that in the other 2 groups. The differences in ability of speach and head lifting of patients among the 3 groups when entering PACU were statistically significant ( P=0.036, P<0.001). No adverse events such as reflux, or aspiration, dyspnea occurred in patients in PACU. Conclusions:The incidence of RNMB in patients undergoing laryngeal surgery entering PACU immediately is high and the degree of RNMB is more severe, with TOFr gradually increasing and RNMB decreasing over time. The patients who receive cisatracurium have a high incidence and severity of postoperative RNMB. Routine monitoring and neuromuscular monitoring in PACU are beneficial for patients′ perioperative safety.

Purpose Mivacurium, the shortest-acting benzylisoquinoline nondepolarizing neuromuscular blocker used in clinical practice, is suitable for short-term ambulatory operations under general anesthesia. We investigated the neuromuscular blockade effect of different maintenance doses of mivacurium during ambulatory vitreoretinal surgery under general anesthesia and tried to determine the appropriate maintenance dose. Patients and Methods Ninety-nine patients undergoing general anesthesia for elective ambulatory vitreoretinal surgery were randomly divided into three groups using the random number table method. Patients received three maintenance doses of mivacurium during surgery as follows: 3 μg/(kg·min) in group M1 (n = 33), 6 μg/(kg·min) in group M2 (n = 33), and 9 μg/(kg·min) in group M3 (n = 33). The primary outcome was the time from mivacurium withdrawal to a train-of-four stimulation ratio (TOFr) ≥ 0.9, and the secondary outcomes were the time from mivacurium withdrawal to TOFr ≥ 0.7, extubation time, incidence of TOFr < 0.9 after surgery and neuromuscular block effect. Results The time from mivacurium withdrawal to TOFr ≥ 0.9 and to TOFr ≥ 0.7 was significantly longer in group M3 than in groups M1 and M2 (25.6±7.2 min vs 16.4±5.9 min and 18.6±5.3 min, P < 0.001; 22.1±6.3 min vs 13.6 ± 5.8 min and 15.5 ± 4.8 min; P < 0.001, respectively). There was a significant difference in the extubation time, the incidence of TOFr < 0.9 during extubation and upon leaving the operating room between group M3 and group M1 (all P < 0.05), but there was no such significant difference between group M2 and group M1 (all P > 0.05). The intraoperative depth of neuromuscular blockade in the three groups was significantly different, with 69.7% shallow block in group M1, 75.8% moderate block in group M2 and 63.6% deep block in group M3 (P < 0.001). One patient in group M1 experienced slight body movement during the operation. Conclusion An intraoperative continuous infusion of 6 μg/(kg·min) mivacurium can not only achieve good postoperative recovery but also provide a satisfactory neuromuscular blockade effect during surgery, and this maintenance dose is suitable for neuromuscular blockade during ambulatory vitreoretinal surgery.

目的 观察全麻声带手术患者在麻醉后恢复室中肌松残余情况.方法 选取2020年7月～2021年3月行声带手术的患者,运用肌松监测观察患者到达恢复室时四个成串比值(a train-of-four rate,TOFr),根据肌松残余程度分3组,Ⅰ组:TOFr＜0.7(严重肌松残余),Ⅱ组:0.7≤TOFr＜0.9(轻度肌松残余),Ⅲ组:TOFr≥0.9(无肌松残余),对三组患者均给予严密护理并记录,每隔5分钟循环一次,直至TOFr≥0.9,且Aldrete评分＞9,达到离开恢复室标准方可送返病房.结果 258例患者中,Ⅰ组患者96例,Ⅱ组患者137例,Ⅲ组患者25例.Ⅰ组顺式阿曲库铵应用比例高于其他两组,差异有统计学意义(P＜0.01),其余麻醉用药及方式差异无统计学意义.Ⅰ组患者在恢复室血氧饱和度偏低、睁眼抬头能力差、需辅助通气发生率高、恢复室停留时间长,差异均有统计学意义(P＜0.01).结论 声带手术患者术后肌松残余发生率为90.3％,严重肌松残余为37.2％;在恢复室中应用肌松监测可及时发现肌松残余,对患者安全有重要作用;与米库氯铵及罗库溴铵相比,顺式阿曲库铵术后肌松残余发生率更高.

目的 对比羟考酮与芬太尼用于七氟烷全身麻醉行眼科手术小儿预防术后躁动的效果.方法 前瞻性选择2018年9～12月在首都医科大学附属北京同仁医院择期行斜视矫正手术的患儿80例,年龄3～7岁,美国麻醉医师协会(ASA)分级Ⅰ～Ⅱ级.采用随机数字表法将患儿分为两组:羟考酮组(0组)及芬太尼组(F组).采用8％七氟醚与4 L/min氧气吸入诱导,待麻醉深度合适后置入喉罩,术中保留自主呼吸单纯七氟烷吸入维持,手术结束前15 min,O组静脉缓慢滴注盐酸羟考酮0.075 mg/kg,F组患儿静脉缓慢滴注芬太尼1μg/kg,并给予同步间歇指令通气(SIMV).术毕停用七氟烷,拔除喉罩送入麻醉恢复室.记录患儿年龄、性别构成比、体重、手术时间、七氟醚吸入时间、意识恢复时间、恢复室停留时间,并定时评估术后躁动评分(PAED)、镇痛评分(FLACC),记录低氧血症、头晕、嗜睡、恶心呕吐及排便障碍等不良反应发生率.结果 O组与F组患儿年龄、性别、体重、手术时间及七氟醚吸入时间比较差异无统计学意义.O组患儿意识恢复时间及恢复室停留时间分别为(15.9±3.8)、(27.9±5.1) min,与F组[(16.1±4.2)、(25.1±4.4) min]比较,差异无统计学意义(P＞0.05).O组患儿术后PAED评分为4.9(3.8)分,与F组6.0(3.4)分比较,差异无统计学意义(P＞0.05);0组患儿术后躁动发生率为10.0％ (4/40),与F组术后躁动发生率15.0％ (6/40)比较,差异无统计学意义(P＞0.05).O组患儿FLACC评分为1.0[2.1],与F组3.6[2.0]比较差异具有统计学意义(P=0.001);O组术后疼痛发生率为5.0％ (2/40),与F组20.0％ (8/40)比较,差异具有统计学意义(P=0.043).两组患儿各种不良反应的发生率比较,差异无统计学意义(P＞0.05).结论 静脉应用羟考酮与芬太尼同样可安全应用于七氟烷全身麻醉行眼科手术小儿,术后躁动发生率低;与芬太尼相比,静脉应用羟考酮的患儿术后疼痛评分更低,舒适度更高.