title: The effects of neuromuscular blockade on operating conditions during general anesthesia for spinal surgery.
abstract: BACKGROUND
  Muscle relaxants are prescribed routinely for patients undergoing general anesthesia, but the requirement for paralysis in spinal surgery is unclear. This study compared the operating conditions of general anesthesia with and without a muscle relaxant on spinal surgery patients.
  
  
  METHODS
  Eighty-six adults who underwent elective spinal surgery were randomly assigned to a relaxant group (group R) or a no-relaxant group (group NR). All patients were induced with intravenous midazolam (0.05 mg/kg), fentanyl (4 µg/kg), propofol (1.0 mg/kg), and succinylcholine (2 mg/kg) and then atracurium was used in group R but not in group NR. The operating conditions, including muscle tone, body movements, airway pressure, anesthetics consumption, eye-opening time, extubation time, and the Observer's Assessment of the Alertness/Sedation (OAA/S) score 20 minutes after the extubation were compared between the 2 groups.
  
  
  RESULTS
  The operating conditions including muscle tone scales, body movements, and airway pressure did not differ between the 2 groups. Eye-opening time (9.35±2.34 vs. 11.02±2.50 min; P=0.002) and extubation time (13.95±3.41 vs. 16.72±3.67 min; P=0.001) were shorter in group NR than in group R. The BIS score at extubation (87.2±5.0 vs. 83.3±5.7; P=0.001) and the OAA/S score 20 minutes after extubation (5 [3 to 5] vs. 4 [3 to 5]; P=0.005) were significantly higher in group NR than in group R. Propofol consumption was higher in group NR than in group R (4206.10±415.80 vs. 3900.60±365.40 μg/kg, respectively; P=0.001).
  
  
  CONCLUSIONS
  General anesthesia without muscle relaxant provides similar working conditions to those observed with muscle relaxant, and it is associated with earlier eye opening and extubation and higher level of consciousness on emergence from spinal surgery.
authors.affiliation: Department of Anesthesiology, The First hospital of Lanzhou University, Lanzhou, P.R. China.
authors.forename: Yu-Lan
authors.initials: YL
authors.lastname: Li
authors.forename: Ying-Long
authors.initials: YL
authors.lastname: Liu
authors.forename: Cheng-Ming
authors.initials: CM
authors.lastname: Xu
authors.forename: Xin-Hua
authors.initials: XH
authors.lastname: Lv
authors.forename: Zhan-Hai
authors.initials: ZH
authors.lastname: Wan
mesh_terms: D000328:Adult; D060666:Airway Extubation; D000403:Airway Resistance; D000762:Anesthesia Recovery Period; D000768:Anesthesia, General / Q000379:methods*; D001279:Atracurium / Q000009:adverse effects; D003243:Consciousness; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D009068:Movement; D009129:Muscle Tonus; D019148:Neuromuscular Blockade / Q000009:adverse effects*; D009466:Neuromuscular Blocking Agents / Q000009:adverse effects*; D009467:Neuromuscular Depolarizing Agents / Q000009:adverse effects; D003473:Neuromuscular Nondepolarizing Agents / Q000009:adverse effects; D019635:Neurosurgical Procedures / Q000379:methods*; D013131:Spine / Q000601:surgery*; D013390:Succinylcholine / Q000009:adverse effects
chemical_list: D009466:Neuromuscular Blocking Agents; D009467:Neuromuscular Depolarizing Agents; D003473:Neuromuscular Nondepolarizing Agents; D001279:Atracurium; D013390:Succinylcholine