Læknablaðið - 15.01.1998, Blaðsíða 16

16
LÆKNABLAÐIÐ 1998; 84
Áhrif vöðvaslakandi lyfja
á vöðvastyrk eftir svæfingar
Erla G. Sveinsdóttir, Sigurbergur Kárason, Sigurpáll Scheving, Kristinn Sigvaldason
Sveinsdóttir EG, Kárason S, Scheving S, Sigvalda-
son K
Postoperative rcstcurarization
Læknablaðið 1998; 84: 16-23
Objective: Muscle relaxants have been used during
anesthesia for the past 50 years but in the last dec-
ades it has been realised that their use can lead to
complications. Studies have shown 20-40% inci-
dence of restcurarization in postanesthesia care
units (PACU) even if neuromuscular monitors are
used during anesthesia. The purpose of this study
was to estimate the frequency of postoperative mus-
cle weakness at the Reykjavík Hospital in Iceland.
Material and methods: Sixty patients, operated for
laparoscopic cholecystectomy or lumbal disc pro-
lapse, given muscle relaxants (vecuronium or pancu-
ronium) during anesthesia were studied in the PA-
CU. The 5-sec headlift test has been shown to be the
best clinical sign of recovery and this sign was used
to find patients with muscle weakness. Glasgow co-
ma score (GCS) was used to evaluate if patients
were too drowsy to co-operate and patients with
GCS <12 were excluded. Measurements were made
after arrival to the PACU and every 30 minutes
thereafter until headlift was at least five seconds.
Results: Incidence of restcurarization was 17% on
arrival to the PACU and these patients were signif-
icantly lower in oxygen saturation before oxygen
supplementation was started. Thirty minutes after
Frá svæfinga- og gjörgæsludeild Sjúkrahúss Reykjavíkur.
Fyrirspurnir, bréfaskipti: Kristinn Sigvaldason, svæfinga- og
gjörgæsludeild Sjúkrahúss Reykjavíkur, Fossvogi, 108
Reykjavík.
Lykilorð: vöðvaslökun, eftirstöðvar vöðvaslökunar, vökn-
unardeild, höfuðlyfta.
arrival 6% were still restcurarized and 3% after 60
minutes. All patients had recovered after 90 min-
utes. No difference was found between patients giv-
en vecuronium or pancuronium in the first two mea-
surements but those with iongest duration of muscle
weakness had received pancuronium.
Conclusion: The study shows that the incidence of
muscle weakness is too high, which might increase
the risk for complications such as hypoxia or respira-
tory failure. To increase patient safety, shorter act-
ing drugs are recommended and the use of new
nervestimulators giving the train-of-four(TOF)-ra-
tio during muscle blockade could possibly improve
the situation.
Correspondence: Kristinn Sigvaldason, Dpt. of Anesthesia
and Intensive Care, Reykjavík Hospital, 108 Reykjavík, lce-
land.
Key words: muscle relaxants, residualcurarization, recov-
ery, head-lift.
Ágrip
Tilgangur: Vöðvaslakandi lyf hafa verið not-
uð við svæfingar í um hálfa öld. Þau hafa leitt
til mikilla framfara í svæfinga- og skurðlækn-
ingum en eru vandmeðfarin. Æskilegt er að
verkun þeirra sé horfin strax að lokinni skurð-
aðgerð en kannanir hafa sýnt að svo er ekki í
um 20-40% tilvika. í þessari könnun var at-
huguð tíðni eftirstöðva vöðvaslakandi lyfja hjá
sjúklingum á vöknunardeild Sjúkrahúss
Reykjavíkur.
Efniviður og aðferðir: Valdir voru af handa-
hófi 60 sjúklingar sem gengust undir skurðað-
gerð á Sjúkrahúsi Reykjavíkur og fengu vöðva-
slakandi lyf. Til að meta eftirstöðvar vöðva-
slökunar var notuð svokölluð fimm sekúndna
höfuðlyfta en rannsóknir benda til að það sé