机构地区：[1]巴黎大学,巴黎公共援助医院麻醉和重症监护科,圣路易医院,巴黎75010,法国 [2]巴黎大学,巴黎公共援助医院麻醉和重症监护科,科钦医院皇家港,巴黎75014,法国 [3]古斯塔夫-鲁西研究所麻醉科,犹太城94800,法国 [4]里昂贝拉尔中心麻醉科,里昂69008,法国 [5]巴黎公共援助医院麻醉和重症监护科,克劳德·贝尔纳德医院,巴黎75877,法国 [6]罗斯柴尔德基金会医院麻醉和重症监护科,巴黎75019,法国 [7]凡尔赛-伊夫林地区圣康坦大学,巴黎公共援助医院,安布鲁瓦兹·帕雷医院麻醉科,布洛涅-比扬古92100,法国 [8]洛林大学,南锡大学中心医院麻醉和重症监护科,南锡地区54511,法国 [9]里尔大学,赫里兹医院麻醉和重症监护科,里尔59037,法国 [10]洛林癌症研究所麻醉科,南锡地区54519,法国 [11]Marzet-Navarre集团综合医院麻醉科,波城64000,法国 [12]奥弗涅大学消化和肝胆外科,埃斯坦医院,克莱蒙费朗63100,法国 [13]艾克斯-马赛大学,蒂莫内医院麻醉和重症监护科,马赛13385,法国 [14]索邦大学,圣安托万医院,巴黎75012,法国 [15]普瓦提埃大学麻醉和重症监护科,普瓦提埃大学中心医院,普瓦提埃86021,法国
出 处：《中华麻醉学杂志》2022年第7期771-793,共23页Chinese Journal of Anesthesiology
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
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