Combination of neuromuscular block monitoring and hand grip strength assessment for patients undergoing emergency abdominal surgery

Abstract

Relevance. The hand grip strength measurement together with neuromuscular block monitoring played an important role during surgery. They both helped in losing less time during surgery and also facilitate the task of the surgeon. The aim of this study was to reduce time on intubation, facilitate the task of the surgeon and to limit post-surgical pain. In rehabilitation, hand grip strength helps in determining further recuperation measures after asurgery. There are three fundamental principles for an anesthesiologist to ensure that the patient after combined endotracheal anesthesia can be extubated, the first one is to ask the patient to move his head forward, the second one is to ask the patient whether the intubation tube is disturbing him in his mouth and the third most important one is to make the patient hold his wrist very firmly. Materials and Methods. Monitoring of muscle relaxant on induction, intra and post-surgery is carried out using aTOF Watch SX in coordination with handgrip strength measurement on 46 patients aged from 18 to 60 years of BMI of 18-30 kg/m² 15min before endotracheal intubation and 15min, 45min and 210min post extubation by using adynamometer “MEGEON 34090” to help us understand whether after extubation muscle strength changes and to what extent. Also, pre-anesthesiology protocol, combined endotracheal protocol, Microsoft excel advanced, monitoring of hemodynamics, ECG, PEEP, PCO2, PO2, respiratory volume using Drager Fabius. Results and Discussion. The results showed that to reach deep muscle relaxation both atracurium benzilate (FKP Kursk Biofabric company, Kursk, Russia) at TOF 0 took 258.5± 83.5 secs and Cisatracurium benzilate (ZAO Obninsk Chemical pharmaceutical company, Obninsk, Russia) at TOF0-252.4±100.1 secs in emergency patients and basically hand grip strength also was lesser as compared to planned cholecystectomy patients. Conclusion. Rehabilitation was necessary for patients undergoing massive abdominal emergency surgeries underlying the fact that on apain scale 10/10 post surgery, further treatments should be implemented to reduce pain, reduce residual neuromuscular block and muscle weakness after extubation at TOF 90-95%.

Keywords

• hand grip strength
• neuromuscular block
• atracurium benzilate
• cisatracurium benzilate
• rehabilitation
• emergency abdominal surgery