Low Dose Of Neostigmine Reduces Residual Neuromuscular Blockade Incidence Of Intravenous Combined Inhalational Anesthesia With Single Intubation Dose Of Cisatracurium

BACKGROUND:Residual neuromuscular blockade is a common but usually undetected anesthetic problem in the postanesthesia care unit (PACU). A recent survey shows that the application of neuromuscular monitoring and reversal agents is far from universal, for the limited resource of randomized, controlled clinical trials on this topic. METHODS:Sixty patients, randomized divided into 2 groups(S and D), undergoing elective laparoscopic cholecystectomy are studied prospectively. A single intubation dose of cisatracurium(0.15mg/kg) is administrated for induction and no further titration. Intravenous combined inhalational anesthesia is presented with end-tidal sevoflurane concentration 1% and propofol TCI blood concentration 2-2.5ug/ml. Anesthetics are controlled according to the surgical procedure. Neostigmine 0.02mg/kg and atropine 0.01mg/kg are administrated for S group patients when inhalation terminated, while proportional saline for D group. Extubation is performed with clinical test, and TOFR is detected immediately. The inhalation duration, general duration, waiting duration for extubation and TOFR are recorded for comparison. RESULTS:There are no significant differences between 2 groups of the inhalation duration, general duration and waiting duration for extubation. Residual neuromuscular blockade incidence of S group patients (39%) is significantly lower than D group patients (69%). CONCLUTION:The residual neuromuscular blockade incidence is relatively high when using clinical test for extubation, after an short procedure with a single intubation dose of cisatracurium and subsequent intravenous combined inhalational anesthesia. And low dose of neostigmine can make a difference.