Prevention or Overcome: Residual Neuromuscular Blockade—A Narrative Review

Abstract

The incidence of residual paralysis remains high in the postoperative period even after reversal of intermediate-acting neuromuscular blockers when reversal and extubation are done based on clinical features and are minimized with neuromuscular monitoring (NMM). Correlation between the clinical features of neuromuscular recovery and train-of-four ratio (TOFR) in NMM is variable. Complete neuromuscular recovery depends upon various factors such as age, the weight of the patient, and anesthesia-related factors such as depth of neuromuscular blockade, an inhalational agent used, the time interval between the last dose of neuromuscular block, and reversal administration. The incidence of residual paralysis was found to be high when the neuromuscular blockade was reversed with a standard dose of reversal and recent studies have demonstrated that low-dose neostigmine is adequate to reverse the shallow neuromuscular blocking effects. Hence, quantitative NMM should be used for safe practice while conducting general anesthesia.