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

Med J Chin PLA, Vol. 41, No. 3, March 1, 2016 243 [ ] (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=1.031 95%CI 1.017~1.046 P<0.001) PORC PORC [ ] [ ] R614.24 [ ] A [ ] 0577-7402(2016)03-0243-05 [DOI] 10.11855/j.issn.0577-7402.2016.03.14 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 100034, China 2 Department of Anesthesiology, Beijing Cancer Hospital, Beijing 100142, China * Corresponding author, E-mail: 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 [ ] [ ] 100034 ( ) 100142 ( ) [ ] E-mail wangdongxin@hotmail.com

244 2016 3 1 41 3 with increased risk of PORC (OR=0.970, 95%CI 0.956-0.984, 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] 1 1.1 1.2 257 ASA 20~60 (BMI)<30kg/m 2 1.3 (HR) (BP) (SpO 2 ) (ECG) (BIS) 10ml/(kg h) ( 3~4 g/ml) ( 2~3ng/ml) ( 150102.1)0.1mg/kg 3min 3 g/kg PET CO 2 30~35mmHg BIS 40~60 0.02mg/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<0.05 2 2.1 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) 2.3 4 PORC PORC (OR=1.031 95%CI 1.017~1.046 P<0.001 2)

Med J Chin PLA, Vol. 41, No. 3, March 1, 2016 245 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±8.2 43.6±8.2 45.6±8.2 0.048 BMI (kg/m 2 ) 23.8±2.8 23.6±3.0 24.0±2.7 0.273 Hb (g/l) 116.8±16.5 119.5±15.8 115.0±16.7 0.029 Anemia [n(%)] 96(37.4) 33(32.4) 63(40.6) 0.179 Clinical stages of cancer [n(%)] 0.279 34(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) 0.554 Neoadjuvant chemotherapy before surgery [n(%)] 129(50.2) 43(42.2) 86(55.5) 0.037 Duration of anesthesia (min) 106.7±48.9 109.2±38.3 105.0±54.8 0.471 Duration of surgery (min) 82.6±45.4 84.6±36.7 81.2±50.4 0.555 Non-breast conservative surgery [n(%)] 190(73.9) 70(68.6)) 120(77.4) 0.116 Multiple boluses NMBDs administration [n(%)] 153(59.5) 52(51.0) 101(65.2) 0.023 Duration from last dose NMBDs to extubation (min) 72.6±28.7 84.9±29.2 64.0±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) 0.048 0.967(0.926-1.010) 0.127 Neoadjuvant chemotherapy before operation 0.037 0.804 (0.406-1.593) 0.532 Multiple boluses NMBDs administration 0.023 1.137 (0.517-2.502) 0.750 Duration from last dose NMBDs to extubation (min) <0.001 1.031 (1.017-1.046) <0.001 3 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

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