Postoperative awake paralysis in the intensive care unit after cardiac surgery due to residual neuromuscular blockade: a case report and prospective observational study

Abstract

Postoperative residual paralysis after fast-track cardiac surgery was common in our institution and likely contributed to the reported case of postoperative awake paralysis. We suggest that an NMB not be administered after intubation in fast-track patients. If given, however, it must be well communicated to the ICU team upon ICU admission. We further recommend routine assessment of neuromuscular function before sedation is weaned prior to extubation.

Sugammadex as rescue therapy for residual neuromuscular blockade in the intensive care unit

“…1 Complete recovery from NMB before tracheal extubation may avoid complications related to postoperative residual NMB, including the patient's awareness of this unpleasant condition. 1 The authors pointed out that the risk of postoperative residual NMB could be minimized by routinely assessing neuromuscular function before cessation of sedation. 1 However, quantitative neuromuscular function monitoring does not entirely abolish the risk of postoperative residual NMB.…”

“…1 The authors pointed out that the risk of postoperative residual NMB could be minimized by routinely assessing neuromuscular function before cessation of sedation. 1 However, quantitative neuromuscular function monitoring does not entirely abolish the risk of postoperative residual NMB. 2 In some situations (e.g., malfunction, absence of calibration and normalization, peripheral neuropathy, hypothermia), monitoring may be not able to predict accurately an adequate recovery from NMB.…”

“…5 In their conclusions, Roy et al rightly underlined the importance of new solutions, in addition to those readily available, to minimize the consequences of postoperative residual NMB in the ICU. 1 We believe that sugammadex, which has been proven an effective rescue therapy to reverse NMB, should be included in strategies used to prevent postoperative residual NMB and associated CREs in the ICU whenever possible. Editorial responsibility This submission was handled by Dr. Hilary P. Grocott, Editor-in-Chief, Canadian Journal of Anesthesia.…”

Residual neuromuscular blockade in the ICU: a prospective observational study and national survey

“…However, the incidence of residual neuromuscular blockade in the ICU is unclear [9]. Much of the current evidence comes from fast-track cardiac surgical patients, in whom the incidence in ICU ranges from 9% to 66% in the immediate postoperative period [10,11]. There has also been a case report of complete paralysis lasting > 10 h after cardiac surgery [12].…”