Naslov
Intensity of neuromuscular block during intravenous regional anesthesia: the influence of ishemia and/or local anesthetic activity

Autori
Bartolek, Dubravka ; Malović, Mario ; Zdravčević-Šakić, Kata ; Vrbanović, Ilena

Vrsta, podvrsta i kategorija rada
Sažeci sa skupova, sažetak, znanstveni

Izvornik
Regional Anesthesia and Pain Medicine Journal 35(5), Abstracts / Huntoon, Marc A. - Philadelphia (PA) : ASRA, 2010, E68-E68

Skup
The XXIX Annual ESRA Congres of Europen Sociaty of Regional Anaesthesia & Pain Medicine

Mjesto i datum
Porto, Portugal, 08.09.2010. - 11.09.2010

Vrsta sudjelovanja
Poster

Vrsta recenzije
Međunarodna recenzija

Ključne riječi
Bier's block; intravenous regional anesthesia; neuromuscular block; ischemia; local anesthetic

Sažetak
Background and aims: Neuromuscular block (NMB) in IVRA is result of local anesthetic (LA) activity and ischemia in exsanguinated extremity where nerve branches are compressed by tourniquet. Optimal muscle relaxation develops for mostly hand surgery intervention immediately after garroting the arm and LA administering. In same cases poor NMB was noted. Dynamic of NMB during IVRA was the aim of this study. Methods: 44 patients (both gender, ASA I/II) were included in prospective study. Patients were randomized and divided in two groups where hand surgery was performed in infiltration anesthesia (10-15 ml of 1% lidocaine)(Group I) or IVRA (40 ml of 0.5 % lidocaine)(Group LA). Eksangvination and tourniquet (upper arm, 100 mmHg pressure above systolic BP) was applied in bought groups. All patients were premidicated (midazolam 0.5 mg/kg) and sedated (midazolam 0.1 mg/kg, sufentanil 0.1 cg/kg) before procedure. Neuromuscular function was monitored by TOF-stimulation. Acceptable (≤ 5% of control twitch height in presence of 3rd twitch of TOF stimulation) and complete NMB (without twitches or presence of 1st and 2nd twitch), VAS and Ramsay sedation score were measurement. Statistical analysis was performed (SPSS 11.0). Results: VAS score was equal between groups (2-3)(P=0.7568). Under 60 minutes, 7% of NMB was associated with ischemic condition and 93% to LA activity. Acceptable NMB was presented in 96% patients in IVRA what allows satisfied surgical work in 80% of them. Positive correlation was found between pronounced muscular structure and patient psycho-sensitivity with consequently difficult surgery conditions (14% vs. 16% in Group I)(P=0.145). Complete NMB was achieved only in 4% during IVRA but was associated with higher sedation score (4 vs. 2-3). NMB recovered faster in Group I (12.5+/-2 vs.19+/-3 min)(P=0000). Conclusions: Intensity of NMB in IVRA allows good surgical condition where complete NMB is not needed and in absence of pronounced muscular structure.

Izvorni jezik
Engleski

Znanstvena područja
Temeljne medicinske znanosti

POVEZANOST RADA