Monitoring of Neuromuscular block during emergency abdominal surgery

Abstract

Relevance. Sixty percent of cases of residual neuromuscular block (rNMB) were recorded globally, yet this issue of rNMB in critically ill patients remains taboo. To predict any leftover NMB, a train-of-four stimulation (TOF) Watch SX was utilized to track the depth of muscle relaxant in emergency patients both during and after surgery, even when they were transported to the intensive care unit. This study aimed to investigate differences in the variability of neuromuscular block between two distinct surgical procedures: laparoscopic cholecystectomy (the control group) and emergency abdominal surgery (the investigation group). Materials and Methods. Using two different muscle relaxants and assessing their depth using accelerometry notably the TOF Watch SX. A total of 140 patients, aged 18-60 years with a BMI of 18-30 kg/m², participated in the study. Group I underwent planned cholecystectomy (control group), while Group II underwent emergency abdominal surgery (investigation group). The muscle relaxants Ridelat-C, generic of atracurium benzilate (Verofarm OOO, Harabovsk, Russia) and Kruaron, generic of rocuronium bromide (Verofarm OOO, Harabovsk, Russia) were administered, with various monitoring methods, including Drager Fabius, ECG, and lab results, Microsoft Office Professional Plus 2021 advanced with graphs and ANOVA. Results and Discussion. The results demonstrated profound skeletal muscle relaxation for planned cholecystectomy, with TOF 0 achieved at 165.9 ± 95 seconds for Kruaron and 183.3 ± 90 seconds for Ridelat-C. In emergency abdominal surgery, it took 207.1 ± 120 seconds with Kruaron and 255.5 ± 109.5 seconds with Ridelat-C at TOF0. Notably, Kruaron exhibited prolonged effects in Group II, leading to residual neuromuscular block in critically ills even 2.5 hours post-surgery. Conclusion . Neuromuscular blocking agents modestly exacerbated neuromuscular dysfunction, potentially contributing to acquired critical illness polyneuropathy/myopathy, severe sepsis/septic shock, and massive blood loss/haemorrhagic shock. In critically ills, a minimal calculated dose of Kruaron is recommended, while Ridelat-C, which metabolized within the blood plasma without involving the kidneys or liver, might be a better choice. Suggamadex was suggested for reversing Kruaron effects due to its rapid effect as compared to proserine.

Keywords

• neuro muscular block monitoring
• planned cholecystectomy
• emergency abdominal surgery
• kruaron
• ridelat-c
• residual nmb