Alerta!!: La debilidad muscular puede ser una realidad aún después de una recuperación neuromuscular "adecuada"

  2017 Aug 22;17(1):108. doi: 10.1186/s12871-017-0402-7.


Recovery and prediction of postoperative muscle power - is it still a problem?


Zoremba M1,2, Kornmann D3, Vojnar B3, Burchard R4, Wiesmann T3, Wulf H3, Kratz T3,5.

1.  Department of Anaesthesia and Intensive Care Medicine, University of Marburg, Baldinger Strasse, D-35033, Marburg, Germany. Esta dirección de correo electrónico está siendo protegida contra los robots de spam. Necesita tener JavaScript habilitado para poder verlo..
2.  Department of Anaesthesia, Intensive Care Medicine and Pain therapy, Kreisklinikum, Weidenauerstrasse 76, D-57076, Siegen, Germany. Esta dirección de correo electrónico está siendo protegida contra los robots de spam. Necesita tener JavaScript habilitado para poder verlo..
3.  Department of Anaesthesia and Intensive Care Medicine, University of Marburg, Baldinger Strasse, D-35033, Marburg, Germany.
4.  Department of Anaesthesia, Intensive Care Medicine and Pain therapy, Kreisklinikum, Weidenauerstrasse 76, D-57076, Siegen, Germany.
5.  Department of Anaesthesia and Intensive Care Medicine, Clinique Bénigne Joly, 4 Allée Roger Renard, F-21240, Talant, France.

Abstract


BACKGROUND:

In the postoperative period, immediate recovery of muscular power is essential for patient safety, but this can be affected by anaesthetic drugs, opioids and neuromuscular blocking agents (NMBA). In this cohort study, we evaluated anaesthetic and patient-related factors contributing to reduced postoperative muscle power and pulse oximetric saturation.

METHODS:

We prospectively observed 615 patients scheduled for minor surgery. Premedication, general anaesthesia and respiratory settings were standardized according to standard operating procedures (SOP). If NMBAs were administered, neuromuscular monitoring was applied to establish a Train of four (TOF)-Ratio of >0.9 before extubation. After achieving a modified fast track score > 10 at 4 time points up to 2 h postoperatively, we measured pulse oximetric saturation and also static and dynamic muscle power, using a high precision digital force gauge. Loss of muscle power in relation to the individual preoperative baseline value was analysed in relation to patient and anaesthesia-related factors using the T-test, simple and multiple stepwise regression analysis.

RESULTS:

Despite having achieved a TOF ratio of >0.9 a decrease in postoperative muscle power was detectable in most patients and correlated with reduced postoperative pulse oximetric saturation. Independent contributing factors were use of neuromuscular blocking agents (p < 0.001), female gender (p = 0.001), TIVA (p = 0.018) and duration of anaesthesia>120 min (p = 0.019).

CONCLUSION:

Significant loss of muscle power and reduced pulse oximetric saturation are often present despite a TOF-Ratio > 0.9. Gender differences are also significant. A modified fast track score > 10 failed to predict recovery of muscle power in most patients.

TRIAL REGISTRATION:

German Clinical Trial Register DRKS-ID DRKS00006032 ; Registered: 2014/04/03.


COMENTARIO:  

Este estudio alerta nuevamente sobre una condición potencialmente amenazante durante el periodo de recuperación.  Proponen nuevos condicionantes para debilidad muscular postoperatoria, lo cual podría indicar que la función neuromuscular no es el único factor explicativo para debilidad muscular postoperatoria.  La pérdida de masa muscular debe encender en el anestesiólogo una alerta de riesgo por su relación con enfermedad sistémica, pobre acondicionamiento físico y "síndrome de fragilidad".  Por otra parte, resulta especialmente interesante que en este estudio la anestesia total endovenosa esté relacionada con debilidad muscular, lo cual abre una puerta a nuevas líneas de investigación que prueben estos hallazgos.

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