A COMPREHENSIVE AND PROSPECTIVE ANALYSIS TO IMPROVE PATIENT OUTCOMES IN POSTOPERATIVE PERIOD BY OPTIMIZING NEOSTIGMINE DOSE AND TIMING WITH THE HELP OF TOF MONITORING

Abstract

Objective: The objective is to find out the optimum neuromuscular reversal strategy using Train-of-Four (TOF) monitoring in the postoperative period for complete and risk-free recovery without residual paralysis. In this study, the neuromuscular blockade brought on by cisatracurium will be reversed using a neuromuscular monitor (TOF) and neostigmine administered at the best possible time and dose. In addition, we'll look at the prevalence of neuromuscular paralysis that persists after general anesthesia, as some research have revealed that paralysis may worsen and return once patients leave the recovery area. Methods: A comprehensive prospective, randomized, double-blind and prospective analysis was conducted involving various study groups. Demographic data, residual neuromuscular weakness, negative head lift tests, and Visual Analog Scale (VAS) scores were assessed. TOF monitoring was used regularly to tailor neuromuscular reversal strategies. Results: Incidence of regression of TOF ratio<0.9 and incidence of negative head lift test after extubation among different groups were statistically non-significant by Chi square test at 15 min (p value 0.4), 30 min (0.8) and 60 min (p value 0.9). It also concludes that neuromuscular stimulation given for TOF monitoring is well tolerated by different group of the population in terms of VAS score (mean 3.9, ranging from 3.3 to 3.8). Conclusion: This research suggests that tailoring strategies of neostigmine dose and time of its administration according to TOF ratio leads to complete recovery of neuromuscular function with all the doses (20/30/40 micrograms/kg). This study emphasizes the use of neuromuscular monitoring guided reversal methods to attain complete recovery without residual paralysis.