HOW SHOULD POSTOPERATIVE RESIDUAL CURARISATION BE DETECTED? If the neuromuscular blocking effects of a nondepolarising muscle relaxant, which has been administered intraoperatively, persist postoperatively to a degree that neuromuscular function is inadequate, then postoperative residual curarisation is said to be present. Of course, this definition depends on the criteria of "adequate" neuromuscular function. Suggested criteria include those based on simple clinical tests and those based on commonly used techniques for monitoring of neuromuscular function. Clinical indicators of adequate neuromuscular function include tr.e abilities to sustain a headlift for five seconds, to sustain a firm hand-grip or tongue protrusion, to keep the eyes open for five seconds, to cough effectively and the absence of double vision. These tests must be interpreted in the light of the well-recognised differential sensitivities of different skeletal muscles to the effects of muscle relaxants. Since the most important neuromuscular functions are pulmonary ventilation, airway protection and maintenance of airway patency, ideally recovery in these muscles should be measured directly. A reasonable and practicable alternative is to assess muscle groups in which recovery is consistently preceded by that in the diaphragm and muscles of the upper airway. Voluntary hand-grip force can be quantified and used as a measure of postoperative residual muscle weakness. I.' This measure is very sensitive and may be substantially decreased, even when a five-second headlift can be sustained. 2 Corresponding to a degree of skeletal muscle weakness at which maximum inspiratory pressure (MIP) and vital capacity (VC) are decreased to 40070 and 50070 of control values, handgrip strength is reduced to 6070 of its control value J and is undetectable when MIP is-20 cm H20." The *EEA.R.c.S.(I), ER.C.A., Senior Anaesthetic Registrar.
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