Residual neuromuscular block: Awareness of long-term adverse respiratory outcomes after departure from postanesthesia care unit (PACU)

Tan, Zhimin; He, Qiyu; Liu, Yu

doi:10.1016/j.asjsur.2022.12.054

Cited by 2 publications

(1 citation statement)

References 3 publications

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“…Our study was small and did not address the newly appreciated potential for longterm consequences of residual neuromuscular blockades in susceptible patients such as the elderly [32]. Importantly, our study was carried out by the bedside providers rather than a separate study team.…”

Section: Discussionmentioning

confidence: 99%

Reversing Neuromuscular Blockade without Nerve Stimulator Guidance in a Postsurgical ICU—An Observational Study

Calef

Castelgrande

Crawley

et al. 2023

JCM

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We aimed to determine if not using residual neuromuscular blockade (RNB) analysis to guide neuromuscular blockade reversal administration in the postsurgical ICU resulted in consequences related to residual weakness. This single-center, prospective study evaluated 104 patients arriving in a postcardiac surgical ICU. After demonstrating spontaneous movement and T > 35.5 °C, all patients underwent RNB evaluation, and neostigmine/glycopyrrolate was then administered. When patients later demonstrated an adequate Rapid Shallow Breathing Index, negative inspiratory force generation, and arterial blood gas values with minimal mechanical ventilatory support, RNB evaluation was repeated in 94 of the 104 patients, and all patients were extubated. Though RNB evaluation was performed, patients were extubated without considering these results. Eleven of one hundred four patients had not achieved a Train-of-Four (TOF) count of four prior to receiving neostigmine. Twenty of ninety-four patients demonstrated a TOF ratio ≤ 90% prior to extubation. Three patients received unplanned postextubation adjunct respiratory support—one for obvious respiratory weakness, one for pain-related splinting compounding baseline disordered breathing but without obvious benefit from BiPAP, and one for a new issue requiring surgery. Residual neuromuscular weakness may have been unrecognized before extubation in 1 of 104 patients administered neostigmine without RNB analysis. ICU-level care may mitigate consequences in such cases.

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Section: Discussionmentioning

confidence: 99%