Evaluation of Postoperative Residual Curarisation after Administration of Neostigmine or Sugammadex by Diaphragmatic Ultrasonography:A Randomized Double-blind Controlled Trial

Abstract

Objective To evaluate and compare the incidence of postoperative residual curarisation (PORC) after administration of neostigmine or sugammadex by diaphragmatic ultrasonography.Methods A total of 100 patients with American Society of Anesthesiologists grade Ⅰ or Ⅱ who underwent elective joint replacement surgery from March to August in 2021 were randomly enrolled into the neostigmine+atropine group(N+A group,n=51) and sugammadex group(SUG group,n=49) according to a random number table.Muscle relaxation was monitored by train of four(TOF) stimulation of adductor pollicis muscle during anesthesia.The patients in N+A group were administrated with neostigmine 50 μg/kg + atropine 15 μg/kg and those in SUG group with sugammadex 2 mg/kg for reversing muscle relaxation.Endotracheal tube was removed only when TOF ratio≥0.9. Diaphragmatic ultrasonography was performed before surgery,10 min and 30 min after extubation.The right diaphragm excursion during deep breathing(DE-DB) and the diaphragm movement velocity during sniffing(V-S) were measured,with the low-frequency probe placed at the intersection of the right midclavicular line and the right costal margin.The diaphragmatic thickening fraction during deep breathing(TF-DB) was measured with the high-frequency probe placed at zone of apposition.The incidence of PORC was taken as the primary outcome,and DE-DB,TF-DB,and V-S as the secondary outcomes.Results When PORC was defined as TF-DB≤36%,the incidence of PORC in the SUG group was lower than that in the N+A group 10 min(4.3% vs.31.1%;χ2=11.541,P=0.001) and 30 min(0 vs.17.6%;P=0.001) after extubation.When PORC was defined as TF-DB≤36% or DE-DB≤4 cm,the incidence of PORC in the SUG group was also lower than that in the N+A group 10 min(8.2% vs.33.3%;χ2=9.543,P=0.002) and 30 min(0 vs.19.6%;χ2=8.608,P=0.003) after extubation.The DE-DB in the SUG group was higher than that in the N+A group 10 min[(6.5±1.6) cm vs.(5.6±1.4) cm;t=-3.185,P=0.002] and 30 min[(6.9±1.5) cm vs.(6.1±1.4) cm;t=-2.712,P=0.008] after extubation.The TF-DB in the SUG group was also higher than that in the N+A group 10 min[(60.1±18.8)% vs.(49.1±20.0)%;t=2.739,P=0.007] and 30 min[(65.0±20.1)% vs.(49.9±19.1)%,t=-3.686,P<0.001] after extubation.Conclusion Compared with neostigmine,sugammadex can significantly improve the postoperative diaphragm movement and decrease the incidence of PORC.