Preventive strategies of residual neuromuscular blockade in resource-limited settings: Systematic review and guideline

Abstract

Background: Following surgery, neuromuscular paralysis is no longer needed, its action could be quickly and effectively terminated. However, evidences shown that NMBAs often continues in the PACU, even after the administration of acetylcholinesterase inhibitor. Hence, stratifying risks of patients and developing evidence-based guidelines are required by rationalizing residual neuromuscular block preventive strategies in resource limiting setup. Methods: Preferred reporting items for systematic reviews and meta-analyses protocol was used to conduct this review. PubMed, Google Scholar, and Cochrane Library data bases were used to find evidences that helps to draw recommendations and conclusions. Discussion: The incidence of residual neuromuscular block is high in aged, female, and hypothermic patients. Full recovery of neuromuscular block may require 15–30 min after administration of anticholinesterase. Conclusions: Undetected neuromuscular block following the administration of NMBAs is still a common problem in today's anesthesia care. A residual neuromuscular block is a preventable anesthetic complication by application of simple measures like the timing of reversal, appropriate assessment of patient and surgery specific usage of NMBAs. Highlights:

Propensity of use of neuromuscular blocking agents among Indian anaesthesiologists: A questionnaire-based survey

“…16 Studies from Singapore and UK have shown that only 10%-13% of anaesthetists routinely use objective neuromuscular monitoring despite its availability because of additional efforts required. 4 A 2017 consensus statement by an international panel of experts recommended that quantitative (objective) NMB monitoring should be used whenever nondepolarizing NMBs are administered. Until conventional nerve stimulation devices are replaced with quantitative monitoring equipment, use of nerve stimulation monitoring should be mandatory.…”

“…3 Nevertheless, residual neuromuscular block is preventable by adequate monitoring of the patient and timing the reversal and extubation procedures. 4 This survey aimed to understand the use of NMBs among Indian anaesthesiologists, including their choice and dosages of NMBs, neuromuscular monitoring, use of reversal agents for residual neuromuscular block, and incidence of adverse effects. https://doi.org/10.18231/j.ijca.2023.053 2394-4781/© 2023 Author(s), Published by Innovative Publication.…”

Fast-track anaesthesia in cardiac and transplant surgeries- An Indian perspective

“…Prevention of hypothermia and use of a nerve stimulator to assess the degree of the block during the procedure and to detect residual paralysis during recovery from anaesthesia are recommended. 27 Using the smallest dose of an NMB and avoiding the use of long-acting NMBs can prevent residual paralysis. 18 The transplant anaesthesia experts who were in this panel also prefer cisatracurium or atracurium as the NMB of choice for FTA.…”

Methods for Clinical Monitoring of Neuromuscular Transmission in Anesthesiology – A Review

“…The phenomenon of residual neuromuscular block is more common in elderly, female, and hypothermic patients. 11 Fortunately, this can be avoided by the appropriate assessment of a patient and by carefully monitoring the degree of muscle relaxation. 6 Assessment of muscle function on the basis of clinical tests, despite its long history of use, is today considered a very unreliable method and should not be applied in clinical practice.…”

“…The phenomenon of residual neuromuscular block is more common in elderly, female, and hypothermic patients. 11 Fortunately, this can be avoided by the appropriate assessment of a patient and by carefully monitoring the degree of muscle relaxation. 6…”