BACKGROUND Residual neuromuscular blockade (RNMB) after the use of neuromuscular blocking agents (NMBAs) increases postoperative morbidity and mortality. The incidence of RNMB associated with the unmonitored use of NMBAs in our population has not been ascertained. We undertook this study to determine the occurrence of RNMB, defined as train of four (TOF) ratio less than one and to identify the risk factors associated with it. METHODS This was a prospective observational study consisting of patients who received NMBAs and underwent elective surgeries under general anaesthesia. They were monitored with TOF-Watch® SX for RNMB in the post anaesthesia care unit (PACU). RNMB was recorded and confirmed. Demographic and clinical data related to anaesthesia care, surgical procedure and post anaesthesia adverse effects were analysed. RESULTS A total of 195 patients who underwent elective surgeries under general anaesthesia were included in the study. The incidence of residual neuromuscular blockade was 31% with a TOF ratio of <0.9 and 51% with a TOF ratio of <1. RNMB occurred more frequently among the female gender, body mass index (BMI) >25 and hypothermic patients. Residual neuromuscular blockade was shown to be associated with increased use of airway adjuncts in the PACU and commonly used clinical tests were not sensitive to pick up RNMB. CONCLUSIONS The significant incidence of RNMB in the PACU emphasizes the need for anaesthesiologists to be mindful of this potentially serious event. Use of neuromuscular monitor can aid in the detection of RNMB and should be considered especially for the high-risk group. Detection will allow appropriate interventions before serious adverse events occur.
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