Optimised reversal without train‑of‑four monitoring versus reversal using quantitative train‑of‑four monitoring: An equivalence study

Wardhana, Ardyan Prima and Kurniawaty, Juni and Uyun, Yusmein (2019) Optimised reversal without train‑of‑four monitoring versus reversal using quantitative train‑of‑four monitoring: An equivalence study. Indian Journal of Anaesthesia, 63 (5). pp. 361-367. ISSN 0019-5049

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Abstract

Background and Aims: Less residual paralysis in recovery room was demonstrated when train‑of‑four (TOF) monitoring was applied. The aim of this study was to know whether optimisation of neostigmine reversal without TOF monitoring was equivalent to reversal using TOF monitoring. Methods: Seventy two patients, aged 18–60 years, undergoing elective surgery under general anaesthesia (sevoflurane and rocuronium) with intubation were randomised into two interventions: an optimised neostigmine reversal strategy without TOF monitoring (group A, n = 36) and a neostigmine reversal strategy using quantitative TOF monitoring (group B, n = 36). Per‑protocol analysis was performed to compare incidence of residual paralysis in the recovery room between the two groups. Results: Six residual paralyses occurred in group A in the recovery room, whereas one case occurred in group B. The equivalence test showed that the 95% confidence interval of this study was outside the range of equivalence margin (15%). The absolute difference was 13.9%: standard error (SE) =0.068 (P = 0.107; 95% confidence interval (CI): 1%, 27.2%). No subjects had TOF ratio <0.70 in the recovery room. The TOF ratio in the recovery room did not differ between the two groups (mean difference: −2.58; P = 0.05; 95% CI: −5.20, 0.29). One respiratory adverse event occurred in this study. Conclusion: An optimised reversal strategy without TOF monitoring is not equivalent to a reversal strategy based on quantitative TOF monitoring. TOF monitoring should be used whenever applicable, although neostigmine is optimised.

Item Type:	Article
Uncontrolled Keywords:	Neostigmine, residual paralysis, train‑of‑four, reversal, rocuronium
Subjects:	R Medicine > R Medicine (General)
Divisions:	Faculty of Medical
Depositing User:	Ester Sri W. 196039
Date Deposited:	13 Dec 2021 08:30
Last Modified:	13 Dec 2021 08:30
URI:	http://repository.ubaya.ac.id/id/eprint/40819

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