Residual neuromuscular block in elderly patients after surgical procedures under general anaesthesia with rocuronium

Abstract

Residual paralysis remains a major problem in geriatric clinical anaesthesia. Neuromuscular function monitoring is obligatory, and pharmacological reversal of relaxation should be advised in geriatric patients after using relaxants for general anaesthesia.

Blokada nerwowo-mięśniowa u osób w podeszłym wieku

“…In a study examining neuromuscular block induced with vecuronium, Baillard et al [42] reported a higher median age in a group of patients with a detected PORC defined as TOFR < 0.7 compared to patients with greater TOFR values. This was confirmed by the results of two large prospective studies with residual blockade as the primary end-point in elderly patients after the administration of rocuronium [5,43]. In a group of 415 patients Pietraszewski et al [5] proved that if rocuronium is administered empirically and the blockade is not reversed by the end of anaesthesia, PORC (TOFR < 0.9) is commonplace, occurring in 89% of patients aged 65 and older with as many as 44% with TOFR < 0.7.…”

“…This was confirmed by the results of two large prospective studies with residual blockade as the primary end-point in elderly patients after the administration of rocuronium [5,43]. In a group of 415 patients Pietraszewski et al [5] proved that if rocuronium is administered empirically and the blockade is not reversed by the end of anaesthesia, PORC (TOFR < 0.9) is commonplace, occurring in 89% of patients aged 65 and older with as many as 44% with TOFR < 0.7. In younger patients, TOFR values of < 0.9 and < 0.7 were observed in 77 and 20% of patients, respectively.…”

“…This is of importance in patients over 65 years of age, particularly those older than 75. This group of patients is most susceptible to the adverse effects of anaesthetics [3], including decreased heart muscle contractility and hypotension, which pose a risk of cardiac and central nervous system ischaemia [4].Unfortunately, advanced age is accompanied by an increasing risk of postoperative residual curarization (PORC) [5] which, along with intraoperative awareness [6], is one of the most clinically significant complications of the use of muscle relaxants. Residual blockade is currently defined by the train of four ratio (TOFR) < 0.9, although previous reports mentioned TOFR < 0.7.…”

“…Unfortunately, advanced age is accompanied by an increasing risk of postoperative residual curarization (PORC) [5] which, along with intraoperative awareness [6], is one of the most clinically significant complications of the use of muscle relaxants. Residual blockade is currently defined by the train of four ratio (TOFR) < 0.9, although previous reports mentioned TOFR < 0.7.…”

Incidence and Associated Factors of Residual Neuromuscular Block among Patients Underwent General Anaesthesia at University of Gondar Hospital, A Cross-Sectional Study

“…Various reports have identified different factors to have association with the occurrence of postoperative residual neuromuscular blockage including age and gender of the patient, type and dose of muscle relaxant used, type and dose of reversal drug used, type of anaesthesia used intraoperatively, duration of surgery and anaesthesia, time of last dose given and reversed, presence of metabolic derangement, hypothermia, opioid and antibiotics given in the recovery [4,[17][18][19][20][21]. However, the reported magnitudes and associated factors may be different from developed to developing countries and have shown different time trends as the interplay between the various socioeconomics, clinical practice, and limited resources alter in sub-Saharan country setting.…”