Европейский журнал об анастезиологии

7AP8-7
Reversal of neuromuscular blockade and tracheal extubation
in internal carotid artery surgery
Novikov A.
Irkutsk State Medical Universit y of the Ministr y of Health Care of the Russian
Federation, Dept of Anaesthesiology, Irkutsk, Russian Federation
Background and Goal of Study: Recovery and tracheal extubation are potentially
dangerous intraoperative period in internal carotid artery surgery that
is due above all to the risk of hemodynamic instability. It is important to ensure
smooth recovery, as well as prompt recovery of spontaneous breath, and
use all means of hemodynamic control during this period. Estimation of ef fectiveness
of Sugammadex and antireflexive endotracheal tube in anaesthetic
support scheme.
Materials and Methods: Prospective randomized controlled clinical patient
study was approved by the Committee on Ethics of the # 1 Primorsky Krai
Clinical Hospital. All patients were split into two groups. Those of the control
group (n-32) were using traditional endotracheal tube, taking neostigmine for
decurarization. Patients in the treated group (n=30) were using antireflexive
endotracheal tube, with 40 mg of Lidocaine 2% solution being injected
into its irrigation port 10 minutes prior to anticipated recovery, and taking
Sugammadex for reversal of neuromuscular block. All patients were comparable
by gender, sex, comorbidity, type and duration of surgical intervention,
and anaesthetic method. Systemic hemodynamics and neuromuscular
conductivity indices, as well as duration of postoperative artificial pulmonary
ventilation were estimated. Obtained data were processed using Microsof t
Excel-2003 and Statistica for Windows - v. 6.0 sof tware.
Results and Discussion: Hemodynamic profiles had unidirectional pattern
in both groups, yet significant dif ference in hemodynamic values between
two groups that were in average higher in the control group by 16,4 - 22,.2%
(p<0.05) was noted too. Average heart rate values of in the treated group
were significantly lower (p<0.05) than those in the control one by 12.2 - 16.1%.
Emergence of spontaneous sustaining breathing and good muscle tone recovery
to the TOF level of 0.9 were noted virtually immediately for patients
in the treated group. It allowed to cut the duration of postoperative artificial
pulmonary ventilation 1.4 times, comparing with the control group (p<0.05).
Conclusion(s): Combined application of Sugammadex and antireflexive
endotracheal tube in internal carotid artery surgery provides extra opportunities
for hemodynamic control during potentially dangerous anesthesia
and promotes fast and complete recovery of muscle tone and spontaneous
breathing, which allows to cut the duration of postoperative artificial pulmonary
ventilation.