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.