Examining influences of neuromuscular block post tetanic monitoring technique on the quality of surgical conditions: Neuromuscular block and quality of surgical conditions

Abstract

Introduction: Subjective estimation of neuromuscular block (NMB), focused on clinical signs such as visual and tactile estimation, can be very difficult and conducted only on awake patients. Hence, it seems that usage of NMB's objective monitoring should become a component of anaestesiological equipment. Objective: The objective was to establish whether application of acceleromyography using the post-tetanic number method (PTC) for NMB's monitoring creates better conditions for surgical work in comparison to subjective, clinical monitoring of NMB. Materials and methods: This randomized clinical study included 40 patients, operated in the General surgery clinic of Clinical center in Nis. Patients were divided into 2 groups consisting of 20 patients each (n=20). Subjective, clinical monitoring of NMB was used on patients in the first group (ESMkon) in all phases of anaesthesiological flow, while PTC mode (TOF Watch® S) based acceleromyographical monitoring in different phases of NMB was used on the patients in the second group (ESMptc). The conditions were qualitatively graded as acceptable and non acceptable, as well as exceptional, satisfying and difficult, and they were mutually compared between examined groups. Statistical significance is estimated with Fisher's exact test and taken as p<0.05. Results: Surgical conditions were marked as clinically unacceptable in the moment of adding relaxant in 8 (20%) out of total number of examinees, unlike ESMptc group which did not have unacceptable conditions (p<0.01). The number of bad marked surgical conditions in ESMkon takes 8 out of 20, unlike ESMptc group which did not have bad marked conditions, but on the other hand it had 17 out of 20 marked as exceptional (p<0.001). Conclusion: The degree of surgical relaxation is better secured by NMB monitoring by using PTC mode based acceleromyograph in comparison with anaesthesiologist's and surgeon's subjective estimation based monitoring. The greatest number of exceptional surgical conditions was available in ESMptc group, unlike bad surgical conditions which were based in ESMkon group exclusively.

Keywords

• monitoring
• acceleromyography
• neuromuscular block
• surgical conditions