Relajación residual en la unidad de cuidado posanestésico
Residual relaxation in the posanesthetic care unit
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Reyes, L. E., Valencia, A. R., Campo, C. A., & Muñoz, L. A. (2015). Relajación residual en la unidad de cuidado posanestésico. Revista Repertorio De Medicina Y Cirugía, 24(4), 254–260. https://doi.org/10.31260/RepertMedCir.v24.n4.2015.598
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El uso de relajantes neuromusculares en la práctica clínica es cada día más frecuente e indispensable en el acto anestésico y la unidad de cuidado intensivo. Aunque los bloqueantes neuromusculares tanto aminoesteroideos como benzilisoquinolinas de última generación tienen efectos adversos mínimos, la relajación residual es una complicación de incidencia considerable asociada con un incremento en la morbilidad y mortalidad. Debido a esto planteamos la importancia de conocer los diferentes métodos de monitoria del bloqueo neuromuscular con su interpretación, haciendo énfasis en la monitoria con el tren de cuatro (TOF), la razón entre la primera y la cuarta respuesta T4/T1 (TOF RATIO) y estrategias de prevención de la relajación residual. Abreviaturas: TOF, tren de cuatro; PORC, parálisis residual posoperatoria; RNMND, relajantes neuromusculares no despolarizantes; UCPA, unidad de cuidado posoperatorio.
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Referencias
1. Brull SJ, Murphy GS. Residual neuromuscular block: lessons unlearned. Part II: methods to reduce the risk of residual weakness. Anesth Analg. 2010;111(1): 129-40.
2. Combes X, Andriamifidy L, Dufresne E, Suen P, Sauvat S, Scherrer E, et al. Comparison of two induction regimens using or not using muscle relaxant: impact on postoperative upper airway discomfort. Br J Anaesth. 2007;99(2):276-81.
3. Andersen BN, Madsen JV, Schurizek BA, Juhl B. Residual curarisation: a comparative study of atracurium and pancuronium. Acta Anaesthesiol Scand. 1988;32(2):79-81.
4. Claudius C, Garvey LH, Viby-Mogensen J. The undesirable effects of neuromuscular blocking drugs. Anaesthesia. 2009;64 Suppl 1:10-21.
5. Craig RG, Hunter JM. Neuromuscular blocking drugs and their antagonists in patients with organ disease. Anaesthesia. 2009;64 Suppl 1:55-65.
6. Murphy GS. Residual neuromuscular blockade: incidence, assessment, and relevance in the postoperative period. Minerva Anestesiol. 2006;72(3):97-109.
7. Naguib M, Kopman AF, Lien CA, Hunter JM, Lopez A, Brull SJ. A survey of current management of neuromuscular block in the United States and Europe. Anesth Analg. 2010;111(1):110-9.
8. Plaud B, Debaene B, Donati F, Marty J. Residual paralysis after emergence from anesthesia. Anesthesiology. 2010;112(4):1013-22.
9. Capron F, Alla F, Hottier C, Meistelman C, Fuchs-Buder T. Can acceleromyography detect low levels of residual paralysis? A probability approach to detect a mechanomyographic train-of-four ratio of 0.9. Anesthesiology. 2004;100(5):1119-24.
10. Ali HH, Wilson RS, Savarese JJ, Kitz RJ. The effect of tubocurarine on indirectly elicited train-of-four muscle response and respiratory measurements in humans. Br J Anaesth. 1975;47(5):570-4.
11. Murphy GS, Szokol JW, Marymont JH, Franklin M, Avram MJ, Vender JS. Residual paralysis at the time of tracheal extubation. Anesth Analg. 2005;100(6):1840-5.
12. Cammu G, De Witte J, De Veylder J, Byttebier G, Vandeput D, Foubert L, et al. Postoperative residual paralysis in outpatients versus inpatients. Anesth Analg. 2006;102(2):426-9.
13. Fuchs-Buder T, Hofmockel R, Geldner G, Diefenbach C, Ulm K, Blobner M. [The use of neuromuscular monitoring in Germany]. Anaesthesist. 2003;52(6):522-6.
14. Maybauer DM, Geldner G, Blobner M, Pühringer F, Hofmockel R, Rex C, et al. Incidence and duration of residual paralysis at the end of surgery after multiple administrations of cisatracurium and rocuronium. Anaesthesia. 2007;62(1):12-7.
15. Fawcett WJ, Dash A, Francis GA, Liban JB, Cashman JN. Recovery from neuromuscular blockade: residual curarisation following atracurium or vecuronium by bolus dosing or infusions. Acta Anaesthesiol Scand. 1995;39(3):288-93.
16. Ronald MD. Miller Anestesia. Elsevier ed2011.
17. Kopman AF, Yee PS, Neuman GG. Relationship of the train-of-fourfade ratio to clinical signs and symptoms of residual paralysis in awake volunteers. Anesthesiology. 1997;86(4):765-71.
18. Grayling M, Sweeney BP. Recovery from neuromuscular blockade: a survey of practice. Anaesthesia. 2007;62(8):806-9.
19. Fuchs-Buder T, Schreiber JU, Meistelman C. Monitoring neuromuscular block: an update. Anaesthesia. 2009;64 Suppl 1:82-9.
20. Claudius C, Viby-Mogensen J. Acceleromyography for use in scientific and clinical practice: a systematic review of the evidence. Anesthesiology. 2008; 108(6):1117-40.
21 Naguib M, Lien CA, Meistelman C. Anesthesia. 6 ed. Philadelphia: Elsevier/ Churchill Livingstone; 2005. Chapter 34, Pharmacology of Neuromuscular Blocking Drugs; 958-994.e8.
22. Cai YR, Xu J, Chen LH, Chi FL. Electromyographic monitoring of facial nerve under different levels of neuromuscular blockade during middle ear microsurgery. Chin Med J (Engl). 2009;122(3):311-4.
23. Jellish WS, Leonetti JP, Buoy CM, Sincacore JM, Sawicki KJ, Macken MP. Facial nerve electromyographic monitoring to predict movement in patients titrated to a standard anesthetic depth. Anesth Analg. 2009;109(2):551-8.
24. Murphy GS, Szokol JW, Marymont JH, Greenberg SB, Avram MJ, Vender JS. Residual neuromuscular blockade and critical respiratory events in the postanesthesia care unit. Anesth Analg. 2008;107(1):130-7.
25. Fuchs-Buder T, Meistelman C, Alla F, Grandjean A, Wuthrich Y, Donati F. Antagonism of low degrees of atracurium-induced neuromuscular blockade: doseeffect relationship for neostigmine. Anesthesiology. 2010;112(1):34-40.
26. Caldwell JE. Clinical limitations of acetylcholinesterase antagonists. J Crit Care. 2009;24(1):21-8.
27. Bom A, Hope F, Rutherford S, Thomson K. Preclinical pharmacology of sugammadex. J Crit Care. 2009;24(1):29-35.
28. Jones RK, Caldwell JE, Brull SJ, Soto RG. Reversal of profound rocuronium-induced blockade with sugammadex: a randomized comparison with neostigmine. Anesthesiology. 2008;109(5):816-24.
29. Naguib M. Sugammadex: another milestone in clinical neuromuscular pharmacology. Anesth Analg. 2007;104(3):575-81.
30. Claudius C, Karacan H, Viby-Mogensen J. Prolonged residual paralysis after a single intubating dose of rocuronium. Br J Anaesth. 2007;99(4):514-7.
31. Arain SR, Kern S, Ficke DJ, Ebert TJ. Variability of duration of action of neuromuscular-blocking drugs in elderly patients. Acta Anaesthesiol Scand. 2005;49(3):312-5.
32. Herbstreit F, Peters J, Eikermann M. Impaired upper airway integrity by residual neuromuscular blockade: increased airway collapsibility and blunted genioglossus muscle activity in response to negative pharyngeal pressure. Anesthesiology. 2009;110(6):1253-60.
33. Lee C, Katz RL. Clinical implications of new neuromuscular concepts and agents: so long, neostigmine! So long, sux! J Crit Care. 2009;24(1):43-9.
34. Eikermann M, Vogt FM, Herbstreit F, Vahid-Dastgerdi M, Zenge MO, Ochterbeck C, et al. The predisposition to inspiratory upper airway collapse during partial neuromuscular blockade. Am J Respir Crit Care Med. 2007;175(1):9-15.
2. Combes X, Andriamifidy L, Dufresne E, Suen P, Sauvat S, Scherrer E, et al. Comparison of two induction regimens using or not using muscle relaxant: impact on postoperative upper airway discomfort. Br J Anaesth. 2007;99(2):276-81.
3. Andersen BN, Madsen JV, Schurizek BA, Juhl B. Residual curarisation: a comparative study of atracurium and pancuronium. Acta Anaesthesiol Scand. 1988;32(2):79-81.
4. Claudius C, Garvey LH, Viby-Mogensen J. The undesirable effects of neuromuscular blocking drugs. Anaesthesia. 2009;64 Suppl 1:10-21.
5. Craig RG, Hunter JM. Neuromuscular blocking drugs and their antagonists in patients with organ disease. Anaesthesia. 2009;64 Suppl 1:55-65.
6. Murphy GS. Residual neuromuscular blockade: incidence, assessment, and relevance in the postoperative period. Minerva Anestesiol. 2006;72(3):97-109.
7. Naguib M, Kopman AF, Lien CA, Hunter JM, Lopez A, Brull SJ. A survey of current management of neuromuscular block in the United States and Europe. Anesth Analg. 2010;111(1):110-9.
8. Plaud B, Debaene B, Donati F, Marty J. Residual paralysis after emergence from anesthesia. Anesthesiology. 2010;112(4):1013-22.
9. Capron F, Alla F, Hottier C, Meistelman C, Fuchs-Buder T. Can acceleromyography detect low levels of residual paralysis? A probability approach to detect a mechanomyographic train-of-four ratio of 0.9. Anesthesiology. 2004;100(5):1119-24.
10. Ali HH, Wilson RS, Savarese JJ, Kitz RJ. The effect of tubocurarine on indirectly elicited train-of-four muscle response and respiratory measurements in humans. Br J Anaesth. 1975;47(5):570-4.
11. Murphy GS, Szokol JW, Marymont JH, Franklin M, Avram MJ, Vender JS. Residual paralysis at the time of tracheal extubation. Anesth Analg. 2005;100(6):1840-5.
12. Cammu G, De Witte J, De Veylder J, Byttebier G, Vandeput D, Foubert L, et al. Postoperative residual paralysis in outpatients versus inpatients. Anesth Analg. 2006;102(2):426-9.
13. Fuchs-Buder T, Hofmockel R, Geldner G, Diefenbach C, Ulm K, Blobner M. [The use of neuromuscular monitoring in Germany]. Anaesthesist. 2003;52(6):522-6.
14. Maybauer DM, Geldner G, Blobner M, Pühringer F, Hofmockel R, Rex C, et al. Incidence and duration of residual paralysis at the end of surgery after multiple administrations of cisatracurium and rocuronium. Anaesthesia. 2007;62(1):12-7.
15. Fawcett WJ, Dash A, Francis GA, Liban JB, Cashman JN. Recovery from neuromuscular blockade: residual curarisation following atracurium or vecuronium by bolus dosing or infusions. Acta Anaesthesiol Scand. 1995;39(3):288-93.
16. Ronald MD. Miller Anestesia. Elsevier ed2011.
17. Kopman AF, Yee PS, Neuman GG. Relationship of the train-of-fourfade ratio to clinical signs and symptoms of residual paralysis in awake volunteers. Anesthesiology. 1997;86(4):765-71.
18. Grayling M, Sweeney BP. Recovery from neuromuscular blockade: a survey of practice. Anaesthesia. 2007;62(8):806-9.
19. Fuchs-Buder T, Schreiber JU, Meistelman C. Monitoring neuromuscular block: an update. Anaesthesia. 2009;64 Suppl 1:82-9.
20. Claudius C, Viby-Mogensen J. Acceleromyography for use in scientific and clinical practice: a systematic review of the evidence. Anesthesiology. 2008; 108(6):1117-40.
21 Naguib M, Lien CA, Meistelman C. Anesthesia. 6 ed. Philadelphia: Elsevier/ Churchill Livingstone; 2005. Chapter 34, Pharmacology of Neuromuscular Blocking Drugs; 958-994.e8.
22. Cai YR, Xu J, Chen LH, Chi FL. Electromyographic monitoring of facial nerve under different levels of neuromuscular blockade during middle ear microsurgery. Chin Med J (Engl). 2009;122(3):311-4.
23. Jellish WS, Leonetti JP, Buoy CM, Sincacore JM, Sawicki KJ, Macken MP. Facial nerve electromyographic monitoring to predict movement in patients titrated to a standard anesthetic depth. Anesth Analg. 2009;109(2):551-8.
24. Murphy GS, Szokol JW, Marymont JH, Greenberg SB, Avram MJ, Vender JS. Residual neuromuscular blockade and critical respiratory events in the postanesthesia care unit. Anesth Analg. 2008;107(1):130-7.
25. Fuchs-Buder T, Meistelman C, Alla F, Grandjean A, Wuthrich Y, Donati F. Antagonism of low degrees of atracurium-induced neuromuscular blockade: doseeffect relationship for neostigmine. Anesthesiology. 2010;112(1):34-40.
26. Caldwell JE. Clinical limitations of acetylcholinesterase antagonists. J Crit Care. 2009;24(1):21-8.
27. Bom A, Hope F, Rutherford S, Thomson K. Preclinical pharmacology of sugammadex. J Crit Care. 2009;24(1):29-35.
28. Jones RK, Caldwell JE, Brull SJ, Soto RG. Reversal of profound rocuronium-induced blockade with sugammadex: a randomized comparison with neostigmine. Anesthesiology. 2008;109(5):816-24.
29. Naguib M. Sugammadex: another milestone in clinical neuromuscular pharmacology. Anesth Analg. 2007;104(3):575-81.
30. Claudius C, Karacan H, Viby-Mogensen J. Prolonged residual paralysis after a single intubating dose of rocuronium. Br J Anaesth. 2007;99(4):514-7.
31. Arain SR, Kern S, Ficke DJ, Ebert TJ. Variability of duration of action of neuromuscular-blocking drugs in elderly patients. Acta Anaesthesiol Scand. 2005;49(3):312-5.
32. Herbstreit F, Peters J, Eikermann M. Impaired upper airway integrity by residual neuromuscular blockade: increased airway collapsibility and blunted genioglossus muscle activity in response to negative pharyngeal pressure. Anesthesiology. 2009;110(6):1253-60.
33. Lee C, Katz RL. Clinical implications of new neuromuscular concepts and agents: so long, neostigmine! So long, sux! J Crit Care. 2009;24(1):43-9.
34. Eikermann M, Vogt FM, Herbstreit F, Vahid-Dastgerdi M, Zenge MO, Ochterbeck C, et al. The predisposition to inspiratory upper airway collapse during partial neuromuscular blockade. Am J Respir Crit Care Med. 2007;175(1):9-15.
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