No Repression of the Functional Recovery of Muscle and Respiration by Residual Cis-atracurium During Re-transfusion of Intraoperative Blood Salvage: A Single-center Prospective Study

  Objective  Intraoperative blood salvage (IBS) is a commonly used technique of blood protection in the clinic. However, salvaged blood may contain muscle relaxant and lead to repression of the functional recovery of muscle and respiratory after surgery. Cis-atracurium besilate (Cisa) is a new type of muscle relaxant. The aim of this study was to investigate the safety of Cisa in patients receiving IBS.

  Methods  Fifty patients with lumbar disc herniation who received lumbar decompression and internal fixation under general anesthesia in the Department of Spine, Beijing Jishuitan Hospital from March to June 2017 were prospectively and sequentially enrolled. The first 25 patients were included in the experimental group and the last 25 in the control group. Cisa was used as the muscle relaxant during general anesthesia. In both groups, the IBS technique was used to collect and wash the autologous blood from the surgical field. In the post anesthesia care unit, train-of-four stimulation (TOF) was monitored every 5 min for 40 min after extubation to evaluate the recovery of muscle function. The salvaged blood was one-timely re-transfused after extubation in the experimental group and 40 min later in the control group. The arterial partial pressure of oxygen (PaO₂) and the partial pressure of carbon dioxide in the artery (PaCO₂) were assessed before anesthesia and immediately after observation to evaluate the respiratory function.

  Results  All patients in both groups finished the whole observation. There were 25 men and 25 women with average age of (55.1±11.1)years and weight of (72.7±9.8)kg. The basic data between two groups were matched. An upward trend of TOF was shown with time, while the increase of TOF at the 40-min point showed no statistical difference between the two groups [(9.6±7.3)% vs. (9.5±8.1)%, P=0.963]. Patients in both groups underwent respiratory insufficiency by the end of observation, but there was no statistical difference in PaCO₂-incr[4.4(2.0, 8.0)mm Hg vs. 4.8(0, 7.1)mm Hg, P=0.312](1 mm Hg=0.133 kPa) and PaO₂-decr[3.2(-2.4, 7.9)mm Hg vs. 7.2(-1.6, 13.0)mm Hg, P=0.133] between groups.

  Conclusion  Cisa is safe as a muscle relaxant for patients receiving IBS under general anesthesia.