Background and Goal of Study: The use of muscle relaxants in outpatient anaesthesia is controversial, some authors recommend an induction regimen including propofol and opioids without muscle relaxants (1). This study evaluated the intubating conditioning in otorhinolaryngeal (ORL) ambulatory surgery with and without muscle relaxant and the immediate and intermediate post operrative recovery.
Methods: We examined in three groups (n = 20 for each) of ASA I-II patients the intubating conditions four minutes after induction of anesthesia with remifentanil 0.5 mcg/kg/min, propofol 2 mg/kg without muscle relaxant (A) or with rocuronium 0.6 mg/kg (B) or with cisatracurium 0.15 mg/kg (C). The time course of neuromuscolar block was determined by TOF Guard® using train of four stimulation (TOF). Anaesthesia was maintained with remifentanil 0.25mcg/kg/min and propofol 6-8mg/kg/h. Residual block was antagonized at T1 recovery of 25% with neostigmine 50mcg/kg and atropine 15mcg/kg. We have evaluated the intubating conditions with and without muscle relaxant; the onset time as maximal suppression of T1; time to 25% T1 recovery (duration of action), TOF ratio ≥0.9 recovery, postoperative recovery in phase I (Aldrete's score ≥9) and II (PADDS ≥ 9) (2,3).
Results: Intubating conditions were good or excellent in group B and C, in group A they were good only in 50% of patients because of cough and movements after orotracheal tube positioning.
Conclusions: Rocuronium and cisatracurium do not influence the discharge times in ambulatory surgery. The post anesthetic discharge scoring system (PADDS) show that the use of non depolarizing muscle relaxant has no influence on the recovery and home-readiness. 70% of patients were discharged 2 h and 3% 3 h after surgery.
1 Schlaich N, Mertzlufft M, Soltész S et al. Acta Anaesth. Scand 2000; 44: 720-726.
2 Chung F et al. Anesth. Analg 1995; 80: 896-902.
3 Aldrete JS et al. Anesth. Analg 1970; 49: 924-934.