Diaphragm Ultrasound to Predict Posteroperative Residual Blockade

Peking Union Medical College Hospital75 enrolled

Overview

This study is a prospective observational research approved by the Ethics Committee of the Peking Union medical college Hospital. Patients scheduled for elective non-abdominal and non-thoracic surgery among age of 19-65 years and American Society of Anesthesiologists Physical Status Classification(ASA) I or II were inrolled. Diaphragm ultrasonogram was measured pre and post operation. Diaphragm excursion and diaphragm thickening fraction during quiet breathing as well as deep breathing were assessed. Neuromuscular monitor was performed during operation, after proper calibration.

Study Type

OBSERVATIONAL

Enrollment

Conditions

Ultrasonography Residual Curarization

Interventions

no interventionOTHER

no intervention

Eligibility

Medical Language ↔ Plain English

Enrollment criteria： 1. Patients who were scheduled for elective non-abdominal and non-thoracic surgery in Peking Union medical college hospital. 2. age of 19-65 years 3. American Society of Anesthesiologists Physical Status Classification(ASA) I or II. 4. Agree to informed consent Exclusion criteria ： Patients with neuromuscular diseases, diaphragmatic palsy, thoracic malformation, hand disabilities, chronic obstructive pulmonary disease, severe liver or kidney diseases, electrolyte or acid-base disorders, morbid obesity (body mass index ≥30 kg/m2), pregnancy, allergy to drugs used in the study, use of medication interfering neuromuscular transmission within 72hours and patients with predicted difficulty in maintenance of airway were excluded from this study. Written informed consent will be obtained before preoperative evaluation by an anesthesiologist.

Outcomes

Primary Outcomes

TOFr at extubation

Neuromuscular function was monitored thoughout operation based neuromuscular monitoring guideline by an independent investigator. TOF ratio before extubation was recorded. The scale of TOFr range from 0 to 1. TOFr\<0.9 indicate existance of residual neuromuscular blockade.

Time frame: within1 min before extubation

Diaphragm ultrasound parameter

Diaphragm excursion and thickening fraction was measured through ultrasonography within 2 min after extubation. Correlation between TOFr ratio and diaphragm parameters was explored.

Time frame: within 1 min after extubation

Secondary Outcomes

reintubation rate

If patients cannot breath by themselves after extubation, They need to be reintubated and mechanical ventilation need to be use to sustain their breathing.

Time frame: within 24 hour

Posteroperative pulmonary complication

incidence of airway obstruction, bronchospasm, pulmonary aspiration of gastric contents, apnea, unexpected ICU admissions, atelectasis and pneumonia

Time frame: 1 month