Postoperative residual block after intermediate‐acting neuromuscular blocking drugs

Abstract

SummaryThe frequency and duration of postoperative residual neuromuscular block on arrival of 150 patients in the recovery ward following the use of vecuronium (n 50), atracurium (n 50) and rocuronium (n 50) were recorded. Residual block was defined as a train-of-four ratio of ,0.8. An additional group of 10 patients received no neuromuscular blocking drugs during anaesthesia. The incidence of postoperative residual neuromuscular block was 64%, 52% and 39% after the use of vecuronium, atracurium and rocuronium, respectively. Similar numbers of patients were not able to maintain a sustained head or leg lift for 5 s on arrival in the recovery ward. The mean [range] times to attaining a train-of-four ratio of $0.8 after arrival in the recovery ward were 9.2 [1±61], 6.9 [1±24] and 14.7 [1.5±83] min for vecuronium, atracurium and rocuronium, respectively. None of the 10 patients who did not receive neuromuscular blocking drugs had train-of-four ratios ,0.8 on arrival in the recovery ward. It is concluded that a large proportion of patients arrive in the recovery ward with a train-of-four ratio ,0.8, even with the use of intermediate-acting neuromuscular blocking drugs. Although the residual block is relatively short lasting, it may occasionally be prolonged, requiring close observation and monitoring of such patients in the recovery ward.

Residual curarization and postoperative respiratory complications following laparoscopic sleeve gastrectomy. The effect of reversal agents: sugammadex vs. neostigmine

“…This wide range of incidence can be explained by the variability in the definition of residual curarization, duration of muscle relaxant action, the use and type of neuromuscular monitoring, and the use or avoidance of reversal. The incidence of postoperative residual curarization may therefore be as high as 59% without reversal administration for intermediate-acting muscle relaxants, and approximately 48% when neostigmine is given as the reversal agent [9].…”

“…A sample size was calculated, based on the assumption that each episode of residual curarization may potentially be associated with a respiratory event/ complication. The calculation indicated that a sample size of 150 (n=75 in each group) would have an 80% power to detect a true, between-group difference (neostigmine group vs. sugammadex group) of partial curarization [9]. Anaesthesia was induced with fentanyl 100 µg, midazolam 1 mg, propofol 1-2 mg/kg ("sleep" dose) and rocuronium 0.6 mg/kg both given by total body weight.…”

Monitorización intraoperatoria del bloqueo neuromuscular y la presión arterial con un solo dispositivo (TOF-Cuff): estudio comparativo con la mecanomiografía y la presión arterial invasiva

“…La incidencia de BNMR presenta una gran variabilidad con porcentajes que oscilan entre el 2% y el 64% 87,93,94,95,96,97,98,99,100,101,102,103,104,105 .…”

The Incidence of Residual Curarization Associated with Vecuronium and the Effect of Age Groups

“…Vekuronyumun indüklediği rezidüel küra-rizasyon, hipoksik ventilatuar cevabı, hiperkapnik ventilatuar cevaba göre daha fazla bozduğu bildirilmiştir (6). Sonuç olarak postoperatif rezidüel kürarizasyonun, hipoksi için önemli bir risk faktörü olduğu vurgulanmıştır (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18).…”