Korean J Anesthesiol.  2006 Aug;51(2):167-173. 10.4097/kjae.2006.51.2.167.

The Influence of Patient Controlled Analgesia on the Recovery of Muscle Power and Respiratory Function following Intraoperative Muscle Relaxants

• Kim SH
• Han OS
• Jung HS
• Kim DS
• Ryu SJ
• Chang TH
• Kim KH

• KMID: 1936655
• DOI: http://doi.org/10.4097/kjae.2006.51.2.167

Abstract

BACKGROUND: Residual muscle paralysis after anesthesia is reduced with the advent of intermediate-acting neuromuscular blocking drugs, yet the incidence is as high as about 10 percent. Opioids in patient-controlled analgesia (PCA) may cause respiratory depression and other problems after anesthesia. The purpose of this study is to evaluate the influence of PCA on the SPO2, TOF ratio, head-lift and tongue protrusion during recovery room stay following intraoperative muscle relaxants.
METHODS
120 patients aged from 20 to 65 in ASA class I and II were divided into control or PCA groups. All patients received rocuronium (0.9 mg/kg) or atracurium (0.5 mg/kg) for tracheal intubation, and maintenance of relaxation was done with atracurium 0.2 mg/kg/hr during inhalation anesthesia. Reversal of block was done with pyridostigmine 0.15 mg/kg and glycopyrrolate 0.2 mg. SpO2, TOF ratio, 5 sec-head lift, tongue protrusion tests were evaluated in the recovery room.
RESULTS
IV-PCA did not influence the incidence of residual block, SPO2, TOF ratio during recovery room stay for 20 minutes, but influenced negatively 5 sec-head lift test, tongue protrusion test only immediately after arrival at the recovery room.
CONCLUSIONS
Since IV-PCA decreased the ability to perform head-lift and tongue protrusion early postoperatively, it is recommended that patients with IV-PCA should be carefully managed against the risk of aspiration or upper respiratory obstruction during their early recovery room stay.

Keyword

head-lift test; muscle relaxant; patient-controlled analgesia; SpO2; TOF ratio; tongue protrusion test

MeSH Terms

Analgesia, Patient-Controlled*
Analgesics, Opioid
Anesthesia
Anesthesia, Inhalation
Atracurium
Glycopyrrolate
Humans
Incidence
Intubation
Neuromuscular Blockade
Paralysis
Passive Cutaneous Anaphylaxis
Pyridostigmine Bromide
Recovery Room
Relaxation
Respiratory Insufficiency
Tongue
Analgesics, Opioid
Atracurium
Glycopyrrolate
Pyridostigmine Bromide