| Abstract | Rokuronij je nedepolarizirajući živčano-mišićni blokator, koji se može primjenjivati u ponavljajućim pojedinačnim dozama, ili u trajnoj infuziji tijekom opće anestezije. Zbog osobitosti prelomljenog klečećeg položaja za lumbalnu diskektomiju, moguće su brojne anesteziološke i kirurške komplikacije navedenog zahvata, stoga je potrebna dobra i ujednačena intraoperacijska živčano-mišićna blokada. Dosadašnjim istraživanjima nije obuhvaćeno ispitivanje utjecaja načina primjene rokuronija na mišićnu snagu i kvalitetu oporavka bolesnika nakon anestezije za lumbalnu diskektomiju.
Hipoteza ovog istraživanja bila je da trajna infuzija rokuronija tijekom anestezije za lumbalnu diskektomiju omogućuje bolji oporavak mišićne snage, te bolju kvalitetu oporavka bolesnika mjerenu upitnikom.
Cilj je bio usporediti utjecaj trajne infuzije i pojedinačnih doza rokuronija tijekom lumbalne diskektomije na oporavak bolesnika.
Pritom smo procijenili kako rokuronij primijenjen trajnom infuzijom i pojedinačnim dozama utječe na oporavak mišićne snage mjereći snagu stiska šake dinamometrom. Kvalitetu oporavka bolesnika procijenili smo standardiziranim upitnikom za procjenu kvalitete oporavka bolesnika nakon anestezije i operativnog zahvata (Qor40- Quality of recovery questionnaire).
Ujedno je cilj bio procijeniti primjenjivost hrvatske inačice upitnika Qor-40 u kliničkoj praksi.
U istraživanje je uključeno 80 bolesnika ASA skupine I i II, u dobi između 18 i 65 godina, kod kojih je planirana lumbalna diskektomija. Bolesnici su randmizirano podijeljeni u dvje skupine po 40 bolesnika. Opća anestezija održavana je u obje skupine propofolom i remifentanilom, uz standardni monitoring, te BIS i TOF. U kontrolnoj skupini rokuronij je primjenjen u pojedinačnim odvojenim dozama kada bi TOF omjer bio 5%, a u eksperimentalnoj skupini rokuronij je primjenjen u trajnoj infuziji da TOF bude 5%. Snaga stiska šake mjerena je dinamometrom u tri navrata: prije anestezije, neposredno nakon buđenja iz anestezije u operacijskoj sali, te 24 sata nakon anestezije. Kvaliteta oporavka bolesnika procijenjena je upitnikom Qor-40 prije anestezije, 24 sata nakon anestezije, te 30 dana nakon anestezije i operacije.
Rezultati istraživanja pokazali su da između skupina nema statistički značajne razlike u snazi stiska šake mjerene dinamometrom niti u mjerenju neposredno nakon buđenja iz anestezije, niti nakon 24 sata poslije anestezije.
S obzirom na kvalitetu oporavka bolesnika mjerenu upitnikom Qor-40, pokazali smo statistički značajnu razliku između skupina s obzirom na fizičku neovisnost. Skupina koja je rokuronij dobivala u trajnoj infuziji pokazala je bolju fizičku neovisnost i u periodu 24 sata nakon anestezije, kao i 30 dana nakon anestezije i operacije. U ostalim ispitivanim domenama (bol, psihološka podrška, emocionalno stanje i fizička ugoda) nije bilo razlika između skupina.
Upitnik Qor-40 preveden na hrvatski jezik validan je instrument za procjenu kvalitete oporavka bolesnika nakon anestezije i operativnog zahvata.
Daljnja istraživanja, provedena na većem uzorku, te kroz dulje vrijeme praćenja bolesnika mogla bi dodatno pojasniti utjecaj trajne infuzije rokuronija na oporavak bolesnika nakon lumbalne diskektomije. |
| Abstract (english) | Rocuronium is a non-depolarising neuromuscular blocking agent that can be administered in bolus doses or via continuous infusion during general anesthesia. Due to the specificity of the knee-chest position in a lumbar discectomy, many complications during anesthesia and surgery are possible. Therefore an effective and balanced intraoperative neuromuscular block is needed.
Studies so far have not included a comparison on muscle strength and quality of patient recovery of the effect of continuous infusion and bolus doses of rocuronium during anesthesia for lumbar discectomy.
The hypothesis of this research was that the continuous infusion of rocuronium during general anesthesia for a lumbar discectomy enables better muscle strength recovery, and a better quality of patient recovery as measured by questionnaire.
The aim was to compare the influence of the continuous infusion and bolus doses of rocuronium on patient recovery. Therefore we assessed how continuous infusion and bolus doses of rocuronium affect the recovery of muscle strength as measured by a hand-grip dynamometer. The quality of patient recovery was assessed by standardised questionnaire (Qor-40 - Quality of recovery questionnaire).
The aim was also to evaluate the applicability of the Croatian version of Qor-40 questionnaire in clinical practice.
The research involved 80 patients with ASA classifications I and II, between 18 and 65 years of age, for whom a lumbar discectomy was planned. They were randomly divided into two groups of 40 patients. In both groups, the general anesthesia was maintained with propofol and remifentanil, with standard anesthetic monitoring, BIS and TOF. In the control group, rocuronium was administered in separate bolus doses with the TOF ratio of 5%, while in the experimental group rocuronium was administered via continuous infusion so that theTOF ratio was 5%.
Hand-grip muscle strength was measured with a dynamometer on three occasions: before general anesthesia, in the early post-anesthesia period in the operating room, and 24 hours after anesthesia.
The quality of patient recovery was assessed with a Qor-40 questionnaire before anesthesia, 24 hours after anesthesia, and 30 days after anesthesia and surgery.
The results show there is no statistically significant difference between groups in hand-grip muscle strength as measured with a dynamometer in the early postoperative period, or in the period 24 hours after anesthesia and surgery.
As far as the quality of patient recovery as measured by Qor-40 questionnaire is concerned, the results show a statistically significant difference between groups in terms of physical independence. The group where rocuronium was administered via continuous infusion displayed better physical independence both in period 24 hours after anesthesia and surgery and in the 30 days after. With regard to the other four parameters (pain, patient support, emotional state and physical comfort) there were no differences between the groups.
The Croatian version of the Qor-40 questionnaire is a valid instrument for measuring the quality of recovery after surgery and anaesthesia.
Further research, conducted on a larger sample and with the longer follow-up interval, could additionally explain the influence of the continuous infusion of rocuronium on patient recovery after a lubar discectomy. |
