2018
DOI: 10.4103/ija.ija_652_17
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Reversal agents: do we need to administer with neuromuscular monitoring – an observational study

Abstract: Background and Aims:In clinical practice, in the majority of patients, recovery from the effect of muscle relaxants is assessed using subjective methods such as head lift, eye-opening, or by sustained hand grip after giving anticholinesterases (neostigmine) at the end of surgery. We planned a prospective observational cohort study to test the hypothesis that objective neuromuscular monitoring can help us in avoiding the use of anticholinesterases for reversal.Methods:The patients posted for surgery of <2 h dur… Show more

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Cited by 7 publications
(9 citation statements)
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“…I read with interest the recent publication by Goyal et al . [ 1 ] on the need to administer reversal agents with neuromuscular (NM) monitoring. Two groups of patients were studied – those who received objective NM monitoring and achieved a train-of-four ratio (TOFR) of ≥0.9 at recovery – and the control group, who received neostigmine and were extubated after achieving clinical signs of adequate reversal without NM monitoring.…”
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confidence: 99%
“…I read with interest the recent publication by Goyal et al . [ 1 ] on the need to administer reversal agents with neuromuscular (NM) monitoring. Two groups of patients were studied – those who received objective NM monitoring and achieved a train-of-four ratio (TOFR) of ≥0.9 at recovery – and the control group, who received neostigmine and were extubated after achieving clinical signs of adequate reversal without NM monitoring.…”
mentioning
confidence: 99%
“…supporting tracheal extubation without reversing neuromuscular block made very interesting reading. [ 1 ] Earlier, some authors have been in favour of this concept using atracurium; however, with increasing evidence against this practice, use of reversal agent should be routine. [ 2 ] The authors attempted to establish that with close neuromuscular monitoring after rocuronium, adequate recovery from paralysis may be ensured without anticholinesterases.…”
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confidence: 99%
“…[ 3 ] Interestingly, the incidence of POP is none according to the text and two in one group as shown in Table 3. [ 1 ] Further, authors aspired to assess adequacy of muscle relaxation for intubation and for the maintenance of intraoperative relaxation using neuromuscular monitoring, outcomes of which are not reported.…”
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confidence: 99%
“…in the March 2018 issue of the IJA regarding avoidance of reversal of neuromuscular blockade in patients in whom objective neuromuscular function monitoring was carried out. [ 3 ] In that study, two cohorts of patients were studied; one cohort was exposed to objective, quantitative neuromuscular monitoring (NMM) intraoperatively and at extubation, whereas in the other, no NMM was performed. The groups were allocated based on the surgery list of that day; every alternate patient had NMM and other alternates on same day did not receive NMM.…”
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confidence: 99%
“…However, Goyal et al . [ 3 7 ] and others [ 8 9 ] suggest that, if neuromuscular function is being objectively monitored, it may be safe to allow the neuromuscular function to recover to a TOF ratio >0.9 without giving neostigmine. If neuromuscular blockade is not being objectively monitored with a device that displays the TOF ratio, neuromuscular blockade should always be reversed with neostigmine, as suggested in the three letters [ 4 5 6 ] and by others.…”
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confidence: 99%