Improved neuromuscular blockade using a novel neuromuscular blockade advisory system: a randomized, controlled, clinical trial

TitleImproved neuromuscular blockade using a novel neuromuscular blockade advisory system: a randomized, controlled, clinical trial
Publication TypeJournal Article
Year of Publication2008
AuthorsGilhuly, T. J., B. A. MacLeod, G. A. Dumont, A. M. Bouzane, and S. K. W. Schwarz
JournalAnesth Analg
Volume107
Pagination1609-17
Date PublishedNov
Abstract

{BACKGROUND: Conventional incremental bolus administration of neuromuscular blocking (NMB) drugs is associated with limitations in intraoperative control, potential delays in recovery, and residual blockade in the postanesthetic period. To overcome such limitations, we developed a novel adaptive control computer program, the Neuromuscular Blockade Advisory System (NMBAS). The NMBAS advises the anesthesiologist on the timing and dose of NMB drugs based on a sixth-order Laguerre model and the history of the patient's electromyographic responses. Here, we tested the hypothesis that the use of the NMBAS improves NMB compared to standard care. METHODS: We conducted a prospective, randomized, controlled, blinded, parallel-group, clinical trial with n = 73 patients (ASA physical status I-III) undergoing abdominal surgery under general anesthesia > or =1.5 h with NMB using rocuronium. Patients were allocated to standard care or NMBAS-guided rocuronium administration. The primary outcome variable was the incidence of intraoperative events reflecting inadequate NMB. Secondary outcome variables included train-of-four (TOF) ratios at the end of surgery before reversal, the total doses of rocuronium, reversal agents, anesthetics and other drugs, the incidence of postoperative adverse events, and the incidence of anesthesiologist noncompliance with NMBAS recommendations. RESULTS: Of 73 enrolled patients

URLhttp://dx.doi.org/10.1213/ane.0b013e318185cfb6
DOI10.1213/ane.0b013e318185cfb6

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