The RECITE Study

Fortier, Louis‐Philippe; McKeen, Dolores M.; Turner, Kim; Médicis, Étienne de; Warriner, Brian; Jones, Philip M.; Chaput, A; Pouliot, Jean-François; Galarneau, André

doi:10.1213/ane.0000000000000757

Cited by 158 publications

(26 citation statements)

References 30 publications

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“…The prevalence of residual neuromuscular blockade was 22.0% in our cohort of patients who received low dose atracurium (<2xED 95 ). Other studies on full intubating dose (>2xED 95 ) of atracurium with ETT showed prevalence ranging from 32-64.6% [17][18][19].…”

Section: Discussionmentioning

confidence: 92%

“…Despite the use of atracurium, a sizable proportion of patients (85 out of 109, 78.0%) were not reversed. The RECITE trial also shows a startling rNMB prevalence of 64.6% even among patients who were reversed with neostigmine [18]. None of the patients in our study population were assessed via peripheral nerve stimulator to accurately assess the ToF at the end of the surgery to guide usage of neostigmine.…”

Section: Discussionmentioning

confidence: 94%

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Postoperative Residual Neuromuscular Blockade (rNMB) Following Low-Dose (<2×ED95) Atracurium in Patients Receiving Laryngeal Mask Airway - An Audit Study

Yh¹,

Koh²,

Ayuningtyas³

et al. 2018

Med Saf Glob Health

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Background Post-operative residual neuromuscular blockade (rNMB) is defined as the incomplete recovery of muscle function following intraoperative administration of neuromuscular blockers, evidenced by a train-of-four (ToF) ratio of <0.9 [1], and is associated with various pulmonary and general postoperative complications [2,3], as well as increased risk of 30 day readmission [4]. The prevalence of rNMB varies from 5% to 88% [5-7], and is exacerbated by inappropriate omission of pharmacological reversal [8]. Koh et al. demonstrated the role of low dose atracurium (0.05 mg/kg or 0.1 mg/kg) in improving conditions for LMA insertion [9]. A recent study evaluating risk factors for difficult ventilation with LMA in a major tertiary care hospital in SouthEast Asia also showed that 19% of the patients who had LMA also received neuromuscular blockers [10]. Despite this high prevalence, few studies have evaluated the effects of low dose neuromuscular blockers, and the prevalence of postoperative residual paralysis in such situations is not known [11-14]. In the Koh et al. study cohort, there were rapid spontaneous respiration returned after giving low dose atracurium, and patients were able to achieve good tidal volumes spontaneously. This may result in the anesthesiologists' clinical decision not to reverse patients who were given the low dose atracurium. This study aims to audit the practice of the major tertiary hospital by establishing the prevalence of rNMB in patients undergoing general anesthesia with LMA following a low dose of atracurium (<2xED 95 , or <0.46 mg/kg). Our secondary aim looks at the use of neostigmine in preventing rNMB and if there is a dose-dependent relationship, as well as post-operative complications associated with rNMB.

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Section: Discussionmentioning

confidence: 92%

Section: Discussionmentioning

confidence: 94%

Postoperative Residual Neuromuscular Blockade (rNMB) Following Low-Dose (<2×ED95) Atracurium in Patients Receiving Laryngeal Mask Airway - An Audit Study

Yh¹,

Koh²,

Ayuningtyas³

et al. 2018

Med Saf Glob Health

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“…[7,9,18] In the majority of cases, a single dose of NMB was administered. This may have been related to the duration of most anesthesia (approximately 2 hours), a result similar to those described in other studies.…”

Section: Discussionmentioning

confidence: 99%

“…[2,5–7] Furthermore, the low use of neuromuscular monitoring and undesired effects of inadequate neostigmine doses have sparked a discussion on the use or nonuse of reversal agents. [8] Thus, the study of the use of NMB and their reversal agents is mandatory in clinical practice.…”

Section: Introductionmentioning

confidence: 99%

Use of neuromuscular blockers and neostigmine for general anesthesia and its association with neuraxial blockade

Santos

Braga²,

Junqueira³

et al. 2017

Medicine

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This research aimed to assess the use of neuromuscular blockers (NMB) and its reversal, associated or not with neuraxial blockade, after general anesthesia.This retrospective study analyzed 1295 patients that underwent surgery with general anesthesia at Prof. Dr. José Aristodemo Pinotti Hospital in 2013. The study included patients aged >1 year, with complete, readable medical charts and anesthetic records.Rocuronium (ROC) was the most used NMB (96.7%), with an initial dose of 0.60 (0.52–0.74) mg/kg and total dose of 0.38 (0.27–0.53) mg/kg/h. In 24.3% of the cases, neuraxial blockade was associated with a significantly longer anesthesia (P < .001) than in cases without neuraxial block, regardless of technique (total intravenous (TIV) vs intravenous and inhalational (IV+IN)). In 71.9% of the cases, a single dose of NMB was used. Patients under TIV general anesthesia associated with neuraxial blockade had a lower total dose of ROC (mg/kg/h) in comparison with TIV GA alone (0.30 (0.23–0.39) and 0.42 (0.30–0.56) mg/kg/h, respectively, P < .001). The same was observed for patients under IV+IN GA (0.32 (0.23–0.41) and 0.43 (0.31–0.56) mg/kg/h, respectively, P < .001). The duration of anesthesia was longer according to increasing number of additional NMB doses (P < .001). Dose of neostigmine was 2.00 (2.00–2.00) mg or 29.41 (25.31–33.89) μg/kg. The interval between neostigmine and extubation was >30 minutes in 10.9% of cases.The most widely used NMB was ROC. Neuroaxial blockade (spinal or epidural) was significantly associated with reduced total dose of ROC (mg/kg/h) during general anesthesia, even in the absence of neuromuscular monitoring and regardless of general anesthetic technique chosen. In most cases, neostigmine was used to reverse neuromuscular block. The prolonged interval between neostigmine and extubation (>30 minutes) was neither associated with total doses of ROC or neostigmine, nor with the time of NMB administration. This study corroborates the important role of quantitative neuromuscular monitors and demonstrates that neuraxial blockade is associated with reduced total ROC dose. Further studies are needed to evaluate the possible role of neuraxial blockade in reducing the incidence of postoperative residual curarization.

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“…[ 7 ] Residual paralysis is common at the time of tracheal extubation and arrival at the post-anaesthetic care unit, despite qualitative neuromuscular monitoring and use of neostigmine. [ 8 ]…”

Section: Discussionmentioning

confidence: 99%

Effect of 50% enantiomeric excess bupivacaine mixture combined with pancuronium on neuromuscular transmission in rat phrenic nerve-diaphragm preparation; a pilot study

et al. 2015

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Background and Aims:Local anaesthetics are drugs that are widely used in clinical practice. However, the effects of these drugs on the neuromuscular junction and their influence on the blockade produced by non-depolarising neuromuscular blocking drugs are still under investigation. The aim of this study was to evaluate, in vitro, the influence of a 50% enantiomeric excess bupivacaine mixture on neuromuscular transmission and neuromuscular block produced by pancuronium.Methods:Rats were distributed into three groups (n = 5) according to the drug studied namely, 50% enantiomeric excess bupivacaine mixture (5 μg/mL); pancuronium (2 μg/mL); 50% enantiomeric excess bupivacaine mixture + pancuronium. The following parameters were evaluated: (1) Effects of a 50% enantiomeric excess bupivacaine mixture on membrane potential (MP) and miniature endplate potentials (MEPPs); (2) amplitude of diaphragmatic response before and 60 min after the addition of a 50% enantiomeric excess bupivacaine mixture; the degree of neuromuscular block with pancuronium and pancuronium combined with a 50% enantiomeric excess bupivacaine mixture.Results:A 50% enantiomeric excess bupivacaine mixture did not alter the amplitude of muscle response (MP) but decreased the frequency and amplitude of MEPP. The block produced by pancuronium was potentiated by a 50% enantiomeric excess bupivacaine mixture.Conclusion:A 50% enantiomeric excess bupivacaine mixture used alone did not affect neuromuscular transmission, but potentiated the neuromuscular block produced by pancuronium. No action was shown on the muscle fibre, and alterations on MEPPs demonstrated a presynaptic action.

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The RECITE Study

Abstract: Residual paralysis is common at tracheal extubation and PACU arrival, despite qualitative neuromuscular monitoring and the use of neostigmine. More effective detection and management of NMB is needed to reduce the risks associated with residual NMB.

Cited by 158 publications

References 30 publications

Postoperative Residual Neuromuscular Blockade (rNMB) Following Low-Dose (<2×ED95) Atracurium in Patients Receiving Laryngeal Mask Airway - An Audit Study

Postoperative Residual Neuromuscular Blockade (rNMB) Following Low-Dose (<2×ED95) Atracurium in Patients Receiving Laryngeal Mask Airway - An Audit Study

Use of neuromuscular blockers and neostigmine for general anesthesia and its association with neuraxial blockade

Effect of 50% enantiomeric excess bupivacaine mixture combined with pancuronium on neuromuscular transmission in rat phrenic nerve-diaphragm preparation; a pilot study

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