Postoperative Residual Neuromuscular Paralysis at an Australian Tertiary Children’s Hospital

Ledowski, Thomas; O'Dea, Brendan; Meyerkort, Luke; Hegarty, Mary; Ungern‐Sternberg, Britta S. von

doi:10.1155/2015/410248

Cited by 23 publications

(26 citation statements)

References 13 publications

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“…Ledowski et al reported that in 64 children in the PACU, of whom six had received succinylcholine and 58 a non-depolarizing NMBA, 28.1% had symptoms of residual neuromuscular block and two patients still had a deep neuromuscular block. 21 Taivainen et al measured neuromuscular function by evoked adductor pollis electromyography in 27 infants. All patients received a dose of 0.15 mg/kg cisatracurium at least 15 minutes after intubation.…”

Section: Discussionmentioning

confidence: 99%

Neuromuscular Blocking Agents and Rapid Sequence Induction for Laparoscopic Pyloromyotomy: Impact on Time to Extubation and Perioperative Complications

et al. 2019

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Introduction Infants with hypertrophic pyloric stenosis have gastric outlet obstruction, indicating a pyloromyotomy. To prevent aspiration, a rapid sequence induction (RSI) of anesthesia used to be preferred. However, due to concerns about the side-effects of this technique in infants, a modified RSI with gentle mask ventilation is nowadays mostly used. This research investigates if induction with succinylcholine (classic RSI), cisatracurium (modified RSI), or no neuromuscular blocking agent (NMBA) influences time until extubation and incidence of complications in infants undergoing laparoscopic pyloromyotomy. Materials and Methods A retrospective chart review was performed, observing infants undergoing laparoscopic pyloromyotomy in Erasmus Medical Centre-Sophia Children's Hospital, Rotterdam, from January 2007 until July 2015. Baseline preoperative data, anesthesia and operation details, time to extubation, and reported complications were gathered. Inclusion criteria were maintenance of anesthesia with sevoflurane and a registered extubation time. Exclusion criteria were the use of combinations of NMBAs, repyloromyotomy, and conversion to laparotomy. Results A total of 168 patients were included, of which 21 received succinylcholine, 107 cisatracurium, and 40 no NMBA. Mean duration of surgery was 29 minutes in all three groups; mean duration of anesthesia was 89, 82, and 77 minutes; mean time to extubation was 26, 25, and 23 minutes, respectively, without statistically significant difference. Complications were evenly distributed, no aspiration occurred. Conclusion The use of succinylcholine, cisatracurium, or no NMBA at induction of anesthesia in infants undergoing laparoscopic pyloromyotomy had no statistically significant effect on time until extubation and complication rates. A modified RSI seems to be safe and effective in these cases.

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Section: Discussionmentioning

confidence: 99%

Neuromuscular Blocking Agents and Rapid Sequence Induction for Laparoscopic Pyloromyotomy: Impact on Time to Extubation and Perioperative Complications

et al. 2019

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“…This acetylcholine surge induced by neostigmine has several muscarinic side effects, such as salivation, bronchospasm and even bradycardia, thus predisposing patients for aspiration. [ 30 ] These are prevented by adding an anticholinergic agent with it, but the unpleasant side effects of neostigmine can be avoided by the use of objective neuromuscular monitoring and assessing the actual need for anticholinesterases at the time of reversal. [ 31 32 ]…”

Section: Discussionmentioning

confidence: 99%

Reversal agents: do we need to administer with neuromuscular monitoring – an observational study

et al. 2018

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Background and Aims:In clinical practice, in the majority of patients, recovery from the effect of muscle relaxants is assessed using subjective methods such as head lift, eye-opening, or by sustained hand grip after giving anticholinesterases (neostigmine) at the end of surgery. We planned a prospective observational cohort study to test the hypothesis that objective neuromuscular monitoring can help us in avoiding the use of anticholinesterases for reversal.Methods:The patients posted for surgery of <2 h duration were included in the study. The cohort of patients was formed on the basis of those who were exposed to objective neuromuscular monitoring of recovery (train-of-four [TOF] ratio of 0.9 or more; exposed group) and the patients who were not exposed to objective neuromuscular monitoring (non-exposed group) acting as a control. Using objective neuromuscular monitoring, the time required for recovery from muscle relaxation when neostigmine was not given for reversal was noted and it was then compared with that of the control group.Results:A total of 190 patients were enrolled over a period of 3 years. With the use of TOF ratio of 0.9 for extubation, patients safely recovered from neuromuscular blockade, without using neostigmine, with no difference in the mean recovery time (14.48 ± 1.138 min) as compared to the control group (12.14 ± 1.067 min, P = 0.139). There was no incidence of reintubation in post-operative period.Conclusion:With objective neuromuscular monitoring, we can ensure complete recovery from the neuromuscular blockade while avoiding the use of anticholinesterases.

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“…PRNB was frequently observed in the pediatric patients (28.1%), but more commonly in cases reversed with neostigmine (37.5%), which may be due to the difficulties in assessing related indices as compared with adults and the unreliable onset time and effectiveness without objective neuromuscular monitoring in the children 82. It was held for a long time that higher doses of neostigmine were needed for appropriate antagonism of long-acting NMBDs in children 83.…”

Section: Neostigmine For Special Patientsmentioning

confidence: 99%

Reevaluation and update on efficacy and safety of neostigmine for reversal of neuromuscular blockade

Luo¹,

Chen²,

Min³

et al. 2018

TCRM

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Postoperative residual neuromuscular block is a serious threat which endangers the patient safety. Neostigmine has been the most commonly used anticholinesterase for the pharmacological reversal of neuromuscular blockade. Although newer agents have been introduced recently, neostigmine has some irreplaceable advantages, including broad-spectrum reversal of all nondepolarizing neuromuscular blocking drugs, low cost, and availability of more related data for clinical practice to refer to. Neostigmine is also noticed to have some drawbacks, such as the inability to reverse profound and deep blockade, potential induction of muscle weakness, cardiovascular adverse effects, and so on. Data on the usage of neostigmine in the geriatric and the pediatric population are still insufficient. Some discrepancies are observed in the results from previous studies which need further investigation. However, recent studies offer some renewed information. Regarding both efficacy and safety, the key for successful reversal of neuromuscular blockade is to use neostigmine “appropriately,” optimizing the dosage and timing of administration under close monitoring.

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Postoperative Residual Neuromuscular Paralysis at an Australian Tertiary Children’s Hospital

Cited by 23 publications

References 13 publications

Neuromuscular Blocking Agents and Rapid Sequence Induction for Laparoscopic Pyloromyotomy: Impact on Time to Extubation and Perioperative Complications

Neuromuscular Blocking Agents and Rapid Sequence Induction for Laparoscopic Pyloromyotomy: Impact on Time to Extubation and Perioperative Complications

Reversal agents: do we need to administer with neuromuscular monitoring – an observational study

Reevaluation and update on efficacy and safety of neostigmine for reversal of neuromuscular blockade

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