The Impact of Residual Neuromuscular Blockade, Oversedation, and Hypothermia on Adverse Respiratory Events in a Postanesthetic Care Unit: A Prospective Study of Prevalence, Predictors, and Outcomes

Abstract

The prevalence of RNMB in the PACU was >30%. Older age, open abdominal surgery, and duration of operation <90 minutes were associated with increased risk of RNMB in our patients. Our RR estimate for AREs was highest for depressed level of consciousness. When AREs occur in the PACU, potentially preventable causes including RNMB, hypothermia, and reduced level of consciousness should be readily identified and treated appropriately. Delaying extubation until the patient is awake and responsive may reduce AREs.

Dyspnea due to Residual Neuromuscular Blockade in Elderly Patient with Unrecognized Pre-existing Unilateral Vocal Cord Paralysis

“…Naguib et al [5] reported that about 40% of patients undergoing general anesthesia with the use of neuromuscular blocking agent had TOF ratio of less than 0.9, and about 12% of patients in the PACU had TOF ratio of less than 0.7. Stewart et al [1] also reported that TOF ratio was less than 0.9 in 31% of patients in the PACU. In addition, old age, laparotomy, and short operation time (<90 minutes) were risk factors for residual neuromuscular blockade [1].…”

“…Stewart et al [1] also reported that TOF ratio was less than 0.9 in 31% of patients in the PACU. In addition, old age, laparotomy, and short operation time (<90 minutes) were risk factors for residual neuromuscular blockade [1]. In this patient, residual neuromuscular blockade effect may be considered because TOF ratio was 0.68 in the PACU.…”

“…Incomplete recovery of neuromuscular blockade is one of the most common complications in the PACU [1]. Since the occurrence of residual neuromuscular blockade is affected by many clinical factors, it is difficult to know the incidence accurately.…”

“…In terms of general anesthesia, the neuromuscular blocking agent is one of the most important factors that facilitates tracheal intubation for airway maintenance and helps to accommodate appropriate ventilation patterns of mechanical ventilation, as well as providing appropriate muscle relaxation for surgical manipulation [1]. Monitoring and management of muscle relaxation during general anesthesia can help safe recovery from residual neuromuscular blockade in the post-anesthesia care unit (PACU) and help reduce complications.…”

“…Monitoring and management of muscle relaxation during general anesthesia can help safe recovery from residual neuromuscular blockade in the post-anesthesia care unit (PACU) and help reduce complications. Residual neuromuscular blockade is defined as an insufficient neuromuscular recovery that can be prevented by confirming train-of-four (TOF) ratio >0.9 using objective neuromuscular monitoring [1,2]. Extubation without sufficient reversal after neuromuscular block may cause complication such as dyspnea.…”