摘要
目的为更新1999年法国共识"麻醉中肌肉松弛药与逆转剂的应用"特召集16名专家成立共识委员会。编写开始时宣布庄重的利益声明与分歧监督原则,并在编写过程中予以执行,本指南编写全过程不依赖任何商业资助。所有作者均需遵循推荐分级的评价、制定与评估系统的原则(Grading of Recommendations,Assessment,Development and Evaluation,GRADE?),以评估这些推荐意见的证据质量,规避基于低质量证据做出强推荐的可能性。故有少数推荐意见仍未分等级。方法专家组的讨论主要集中在以下8个问题:(1)在无面罩通气困难标准的情况下,是否有必要在注射肌肉松弛药前检查面罩通气的可行性?面罩通气是否有必要使用肌肉松弛药?(2)为便于气管插管是否有必要使用肌肉松弛药?(3)是否有必要使用肌肉松弛药以便于声门上气道装置的置入及管理相关并发症?(4)是否有必要应用神经肌肉阻滞监测来进行气道管理?(5)是否有必要应用肌肉松弛药以利于手术的进行?如有必要,是哪种手术?(6)术中是否有必要监测神经肌肉阻滞程度?(7)防治肌肉松弛药残留阻滞作用的策略是什么?(8)在特殊人群中(如电休克治疗、肥胖、儿童、神经肌肉疾病、肝/肾功能衰竭、老年患者)使用肌肉松弛药和逆转剂的适应证及注意事项是什么?所有问题都采用研究对象、干预、对照和预后(Population,Intervention,Comparison and Outcome,PICO)模型中的临床问题予以阐明,并生成证据档案,最后采用GRADE?系统评估文献分析的结果并进行推荐。结果SFAR指南专家组提出了31项关于麻醉中应用肌肉松弛药与逆转剂的推荐意见。在这些推荐意见中,有11项是属于强推荐(GRADE 1±),有20项是属于弱推荐(GRADE 2±),有5项应用GRADE?系统无法给出推荐意见,其中2个问题生成了专家意见。经过2轮讨论和1次修订后,所有指南和方案都获得了专家组的一致�
Objectives To provide an update to the 1999 French guidelines on"Muscle relaxants and reversal in anaesthesia",a consensus committee of sixteen experts was convened.A formal policy of declaration and monitoring of conflicts of interest(COI)was developed at the outset of the process and enforced throughout.The entire guidelines process was conducted independently of any industrial funding(i.e.pharmaceutical,medical devices).The authors were required to follow the rules of the Grading of Recommendations,Assessment,Development and Evaluation(GRADE®)system to assess the quality of the evidence on which the recommendations were based.The potential drawbacks of making strong recommendations based on low-quality evidence were stressed.Few of the recommendations remained ungraded.Methods The panel focused on eight questions:(1)In the absence of difficult mask ventilation criteria,is it necessary to check the possibility of ventilation via a facemask before muscle relaxant injection?Is it necessary to use muscle relaxants to facilitate facemask ventilation?(2)Is the use of muscle relaxants necessary to facilitate tracheal intubation?(3)Is the use of muscle relaxants necessary to facilitate the insertion of a supraglottic device and management of related complications?(4)Is it necessary to monitor neuromuscular blockade for airway management?(5)Is the use of muscle relaxants necessary to facilitate interventional procedures,and if so,which procedures?(6)Is intraoperative monitoring of neuromuscular blockade necessary?(7)What are the strategies for preventing and treating residual neuromuscular blockade?(8)What are the indications and precautions for use of both muscle relaxants and reversal agents in special populations(e.g.electroconvulsive therapy,obese patients,children,neuromuscular diseases,renal/hepatic failure,elderly patients)?All questions were formulated using the Population,Intervention,Comparison and Outcome(PICO)model for clinical questions and evidence profiles were generated.The results of the literature an
作者
Benoît Plaud
Christophe Baillard
Jean-Louis Bourgain
Gaëlle Bouroche
Laetitia Desplanque
Jean-Michel Devys
Dominique Fletcher
Thomas Fuchs-Buder
Gilles Lebuffe
Claude Meistelman
Cyrus Motamed
Julien Raft
Frédérique Servin
Didier Sirieix
Karem Slim
Lionel Velly
Franck Verdonk
Bertrand Debaene
Benoît Plaud;Christophe Baillard;Jean-Louis Bourgain;Gaëlle Bouroche;Laetitia Desplanque;Jean-Michel Devys;Dominique Fletcher;Thomas Fuchs-Buder;Gilles Lebuffe;Claude Meistelman;Cyrus Motamed;Julien Raft;Frédérique Servin;Didier Sirieix;Karem Slim;Lionel Velly;Franck Verdonk;Bertrand Debaene(Universitéde Paris,Assistance publique-Hôpitaux de Paris,service d′anesthésie et de réanimation,hôpital Saint-Louis,1,avenue Claude-Vellefaux,75010 Paris,France;Universitéde Paris,Assistance publique-Hôpitaux de Paris,service d′anesthésie et de réanimation,hôpital Cochin-Port Royal,27,rue du Faubourg-Saint-Jacques,75014 Paris,France;Institut Gustave-Roussy,service d′anesthésie,114,rueÉdouard-Vaillant,94800 Villejuif,France;Centre Léon-Bérard,service d′anesthésie,28,promenade Léa-et-Napoléon-Bullukian,69008 Lyon,France;Assistance publique-Hôpitaux de Paris,service d′anesthésie et de réanimation,hôpital Bichat-Claude-Bernard,46,rue Henri-Huchard,75877 Paris cedex,France;Fondation ophtalmologique Adolphe-de-Rothschild,service d′anesthésie et de réanimation,29,rue Manin,75019 Paris,France;Universitéde Versailles-Saint-Quentin-en-Yvelines,Assistance publique-Hôpitaux de Paris,hôpital Ambroise-Paré,service d′anesthésie,9,avenue Charles-de-Gaulle,92100 Boulogne-Billancourt,France;Universitéde Lorraine,CHU de Brabois,service d′anesthésie et de réanimation,rue du Morvan,54511 Vandœuvre-lès-Nancy,France;Universitéde Lille,hôpital Huriez,service d′anesthésie et de réanimation,rue Michel-Polonovski,59037 Lille,France;Institut de cancérologie de Lorraine,service d′anesthésie,6,avenue de Bourgogne,54519 Vandœuvre-lès-Nancy,France;Groupe polyclinique Marzet-Navarre,service d′anesthésie,40,boulevard d′Alsace-Lorraine,64000 Pau,France;Universitéd′Auvergne,service de chirurgie digestive et hépatobiliaire,hôpital d′Estaing,1,rue Lucie-Aubrac,63100 Clermont-Ferrand,France;UniversitéAix-Marseille,hôpital de la Timone adultes,service d′anesthésie et de réanimation,2
出处
《中华麻醉学杂志》
CAS
CSCD
北大核心
2022年第7期771-793,共23页
Chinese Journal of Anesthesiology
关键词
肌肉松弛药
逆转剂
神经肌肉
监测
专家指南更新
Muscle relaxants
Reversal
Neuromuscular
Monitoring
Update of expert guidelines
