Residual neuromuscular blockade and late neuromuscular blockade at the post-anesthetic recovery unit: prospective cohort study

2023 American Society of Anesthesiologists Practice Guidelines for Monitoring and Antagonism of Neuromuscular Blockade: A Report by the American Society of Anesthesiologists Task Force on Neuromuscular Blockade

“…Practice Guidelines table S14, http://links.lww.com/ALN/C928). A train-offour ratio greater than or equal to 0.9 was confirmed before extubation in 10 studies, 41,60,62,68,73,86,118,[173][174][175] greater than or equal to 0.8 or not stated in 5 studies, 3,12,[191][192][193] and unconfirmed in 15 studies 58,59,63,65,66,71,105,181,[183][184][185][186][187][188][189] ; in 9 studies, whether train-of-four ratio was confirmed could not be determined. 43,44,61,67,117,145,147,177,182 Neuromuscular Monitoring: Technical Performance…”

“…The body of evidence included 41 studies (26 randomized controlled trials, 41,59–63,65–68,71,73,86,118,139,145,147,173–181 1 before–after design, 44 4 nonrandomized trials, 142,182–184 6 prospective cohort studies, 105,117,185–188 3 retrospective cohort studies, 43,189,190 and 1 fully paired study 58 ) using quantitative monitoring and sugammadex or neostigmine and reporting residual neuromuscular blockade (train-of-four ratio less than 0.9). For studies stratifying randomization, the arms were considered independent.…”

“…The body of evidence enrolling adults included 191 studies (133 randomized controlled trials, 4,59–90,92,95,98–104,110–114,118–127,132–141,145–148,155–157,163,173–181,206–254 11 nonrandomized trials, 17,128,142,182–184,191,255–258 45 cohort studies, 15,42,86,91,93,94,96,97,105–109,116,117,129–131,143,144,186–190,227,259–277 and 2 before–after designs 115,168 ) evaluating efficacy and safety of antagonist drugs for neuromuscular blockade. The randomized controlled trials enrolling only adults had a median of 88 participants (range, 16 to 350).…”

Authors’ Response to Letters to the Editor of Rajasekar Ramadurai et al Titled “Use of a Standard Predetermined Quantitative Parameter to Signal the Need for Rescue Analgesics.”

“…4,5 In addition, when the train-of-four (TOF) ratio recovered to 30% to 90% after surgery, the dose of neostigmine for reversing neuromuscular block is decreased to 20 µg kg −1 . 6 According to the pharmacokinetics, the average time for the TOF ratio to reach 0.9 was 39.0 minutes when patients were given 0.4 mg kg −1 of rocuronium and 63.3 minutes when patients were given 1.0 mg kg −1 of rocuronium. 7,8 In our study, we injected a single dose of 0.6 mg kg −1 rocuronium at the beginning of the surgery.…”

“…Increasing the dose will not improve the result of reversal, as higher doses have not been reported as more effective 4,5. In addition, when the train-of-four (TOF) ratio recovered to 30% to 90% after surgery, the dose of neostigmine for reversing neuromuscular block is decreased to 20 µg kg −1 6. According to the pharmacokinetics, the average time for the TOF ratio to reach 0.9 was 39.0 minutes when patients were given 0.4 mg kg −1 of rocuronium and 63.3 minutes when patients were given 1.0 mg kg −1 of rocuronium 7,8.…”