PORC (OR= %CI 1.017~1.046 P<0.001)

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1 Med J Chin PLA, Vol. 41, No. 3, March 1, [ ] (PORC) 257 (BIS) 40~60 (0.1mg/kg) Veryark-TOF 4 (TOF) TOF (TOFr) TOFr<0.7 PORC 60.3%(155/257) TOFr<0.9 PORC 93.8%(241/257) Logistic PORC (P>0.05) PORC(OR= %CI 1.017~1.046 P<0.001) PORC PORC [ ] [ ] R [ ] A [ ] (2016) [DOI] /j.issn Incidence and risk factors of postoperative residual curarization in patients with breast cancer: prospective cohort study HE Zi-jing 1, LI Mi 2, CHEN Jing 2, DUAN Jin-chong 2, WANG Dong-xin 1* 1 Department of Anesthesiology, Peking University First Hospital, Beijing , China 2 Department of Anesthesiology, Beijing Cancer Hospital, Beijing , China * Corresponding author, wangdongxin@hotmail.com [Abstract] Objective To determine the incidence and risk factors of postoperative residual curarization (PORC) in patients with breast cancer after total intravenous anesthesia (TIVA) with vecuronium. Methods Two hundred and fiftyseven female patients with breast cancer undergoing breast-cancer surgery were enrolled into the present study. Anesthesia was induced with target-controlled infusion of propofol (Cp 3-4 g/ml) and remifentanil (2-3 ng/ml). A bolus of vecuronium 0.1mg/ kg was administered intravenously over 5-10s as soon as the patient lost consciousness, and laryngeal mask was placed 3min later. Mechanical ventilation and TIVA were performed for maintaining anesthesia and keeping bispectral index (BIS) between 40 to 60 during the operation. According to the duration of operation, 0.02mg/kg of vecuronium was administrated intermittently. Extubation of the laryngeal tube was performed according to clinical criteria. Train-of-four ratios (TOFr) were immediately measured with Veryark-TOF (Guangzhou Weilifangzhou Technology Ltd, China) in the recovery room. The patients were divided into two groups (Group N and Group R) according to the value of TOFr at the time of extubation. N denoted the non-residual neuromuscular blockade group (TOF 0.7), and R denoted the residual neuromuscular blockade group (TOF<0.7). Results The incidence of PORC was 60.3% among 257 patients. There was no significant difference of BMI and duration of anesthesia between groups (P>0.05). In group R, age and hemoglobin level were lower (P<0.05 ), but the incident of anemia was same between groups (32.4% vs. 40.6%, P>0.05). More patients in Group R received neoadjuvant chemotherapy and multiple boluses of vecuronium administration, and the duration between last dose of vecuronium to extubation was also prolonged compared with Group N (P<0.05). Multivariate logistic regression analysis identified that age, neoadjuvant chemotherapy and multiple boluses of vecuronium administration were not associated with increased risk of PORC. Duration from last dose of vecuronium to extubation was associated [ ] [ ] ( ) ( ) [ ] wangdongxin@hotmail.com

2 with increased risk of PORC (OR=0.970, 95%CI , P<0.001). Conclusions PORC is commonly used in patients with breast cancer. Duration from last dose of vecuronium to extubation is associated with increased risk of PORC. [Key words] anesthesia, intravenous; vecuronium bromide; postoperative residual curarization; breast neoplasms (postoperative residual curarization PORC) [1] [2] [3] ASA 20~60 (BMI)<30kg/m (HR) (BP) (SpO 2 ) (ECG) (BIS) 10ml/(kg h) ( 3~4 g/ml) ( 2~3ng/ml) ( )0.1mg/kg 3min 3 g/kg PET CO 2 30~35mmHg BIS 40~ mg/kg >36 VT>6ml/kg 5min 95% (TOF) Ver yark-tof () TOF (TOFr) 1.4 SPSS 18.0 x±s t ( ) χ 2 logistic PORC P<0.05 P< PORCTOFr<0.9 PORC 93.8%(241/257) TOFr<0.7 PORC 60.3%(155/257) 2.2 TOFr<0.9 PORC PORC TOFr<0.7 (N n=102) (R n=155) ASA BMI (P>0.05) R (119.5±15.8g/L) N (115.0± 16.7g/L P <0.05) ( 32.4% 40.6%) (P>0.05) R N R (P<0.05 1) PORC PORC (OR= %CI 1.017~1.046 P< )

3 Med J Chin PLA, Vol. 41, No. 3, March 1, Tab. 1 Baseline and peri-operative data of the total sample Item All patients (n=257) Group N (n=102) Group R (n=155) P value Age (year) 44.8± ± ± BMI (kg/m 2 ) 23.8± ± ± Hb (g/l) 116.8± ± ± Anemia [n(%)] 96(37.4) 33(32.4) 63(40.6) Clinical stages of cancer [n(%)] (13.2) 13(12.7) 21(13.5) 188(73.2) 80(78.4) 108(69.7) 35(13.6) 9(8.8) 26(16.8) Infiltrating ductal carcinoma [n(%)] 194(75.5) 75(73.5) 119(76.8) Neoadjuvant chemotherapy before surgery [n(%)] 129(50.2) 43(42.2) 86(55.5) Duration of anesthesia (min) 106.7± ± ± Duration of surgery (min) 82.6± ± ± Non-breast conservative surgery [n(%)] 190(73.9) 70(68.6)) 120(77.4) Multiple boluses NMBDs administration [n(%)] 153(59.5) 52(51.0) 101(65.2) Duration from last dose NMBDs to extubation (min) 72.6± ± ±25.2 <0.001 TOF ratio < 0.7 is defined as postoperative residual curarization; Group N. Non-residual neuromuscular blockade group; Group R. Residual neuromuscular blockade group; BMI. Body mass index; NMBDs. Neuromuscular blocking drugs 2 PORC logistic Tab. 2 Multivariate logistic regression for risk factors of postoperative residual curarization Variables Univariate analysis Multivariate logistic regression analysis P value OR (95%CI) P value Age (year) ( ) Neoadjuvant chemotherapy before operation ( ) Multiple boluses NMBDs administration ( ) Duration from last dose NMBDs to extubation (min) < ( ) < PORC 60.3% PORC [4-5] PORC 5%~85% TOFr [1, 6-10] 36 Baillard [11] TOFr<0.7 42% PORC Butterly [8] PORC (90% vs 10%) PORC [12-13] PORC

4 [14-16] Prado [17-19] ( 5-Fu ) (50.2%)N R (55.5% vs 42.2%) PORC PORC PORC 30~50 BMI<30kg/m 2 ( ) 1.5~2.5h PORC PORC PORC PORC [1] Xie M, Wang DX, Geng ZY. Prevalence and risk factors of postoperative residual curarization in patients arriving at postanesthesia care unit after general anesthesia: a prospective cohort study[ J]. JAPM, 2014, 1(2): [2] GuoGL,ZhangY,FanLJ,et al. Endoscopic sentinel lymph node biopsy with combined methylene blue and 99m Tc-sulf ur colloid tracing in patients with breast cancer after neoadjuvant chemotherapy (a report of 41 cases)[ J]. Med J Chin PLA, 2010, 35(3): [,,,. ( 41 )[ J]., 2010, 35(3): ] [3] LvBS,WangZQ,WangW,et al. A clinical evaluation of the effect of sevoflurane or propofol in combination with remifentanil in myasthenia gravis patients undergoing thymectomy[ J]. Med J Chin PLA, 2013, 38(7): [,,,. [J]., 2013, 38(7): ] [4] Ge J, Cao XC. New progress in breast cancer patients with early treatment of axillary[ J]. Tianjin Med J, 2013, 41(10): [,. [J]., 2013, 41(10): ] [5] Zhang YH, Liu YJ. A review for the surgical management of breast cancer and the latest developments[ J]. Mod Oncol, 2015, 23(5): [,. [J]., 2015, 23(5): ] [6] Kirkegaard-Nielsen H, Helbo-Hansen HS, Toft P, et al. Anthropometric variables as predictors for duration of action of vecuronium-induced neuromuscular block[ J]. Anesth Analg, 1994, 79(5): [7] Li J, Zhang H. Analysis of postoperative risk factors of residual paralysis[ J]. J Clin Anesth, 2011, 27(1), [,. [J]., 2011, 27(1): ] [8] Butterly A, Bittner EA, George E, et al. Postoperative residual curarization from intermediate-acting neuromuscular blocking agents delays recovery room discharge[ J]. Br J Anaesth, 2010, 105(3): [9] Tao GR, Yu BW. Research progress in postoperative residual curarization[ J]. J Clin Anesth, 2013, 29(8): [,. [J]., 2013, 29(8): ] [10] Caldwell JE. Reversal of residual neuromuscular block with neostigmine at one to four hours after a single intubating dose of vecuronium[ J]. Anesth Analg, 1995, 80(6): [11] Baillard C, Gehan G, Reboul-Marty J, et al. Residual curarization in the recovery room after vecuronium[ J]. Br J Anaesth, 2000, 84(3): [12] Guan WH, Long Y, Yu BM. Research progress of neoadjuvant chemotherapy[ J]. J Int Oncol, 2001, 28(3): [,,. [J]., 2001, 28(3): ] [13] Qiu XH, Wang HX. Clinical observation of neo-adjuvant chemotherapy combined with surgery in the treatment of breast cancer[ J]. Mod Oncol, 2006, 14(4): [,. [J]., 2006, 14(4): ] [14] Jung HW, Kim JW, Kim SW, et al. Effect of muscle mass on toxicity and survival in patientswith colon cancer undergoing adjuvant chemotherapy[ J]. Support Care Cancer, 2015, 23(3): [15] Schaap LA, Pluijm SM, Deeg DJ, et al. Inflammatory markers and loss of muscle mass (sarcopenia) and strength[ J]. Am J Med, 2006, 119(6): 526. [16] Schaap LA, Pluijm SM, Deeg DJ, et al. Higher inflammatory marker levels in older persons: associations with 5-year change in muscle mass and muscle strength[ J]. J Gerontol A Biol Sci Med Sci, 2009, 64(11): [17] Prado CM, Baracos VE, McCargar LJ, et al. Body composition

5 Med J Chin PLA, Vol. 41, No. 3, March 1, as an independent determinant of 5-fluorouracil-based chemotherapy toxicity[ J]. Clin Cancer Res, 2007, 13(11): [18] Prado CM, Baracos VE, McCargar LJ, et al. Sarcopenia as a determinant of chemotherapy toxicity and time to tumor progression in metastatic breast cancer patients receiving capecitabine treatment[ J]. Clin Cancer Res, 2009, 15(8): [19] Prado CM, Lima IS, Baracos VE, et al. An exploratory study of body composition as a determinant of epirubicin pharmacokinetics and toxicity[ J]. Cancer Chemother Pharmacol, 2011, 67(1): ( ) ( )

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