Intraoperative Acceleromyographic Monitoring Reduces the Risk of Residual Neuromuscular Blockade and Adverse Respiratory Events in the Postanesthesia Care Unit

Murphy, Glenn S.; Szokol, Joseph W.; Marymont, Jesse H.; Greenberg, Steven B.; Avram, Michael J.; Vender, Jeffery S.; Nisman, Margarita

doi:10.1097/aln.0b013e318182af3b

Cited by 283 publications

(213 citation statements)

References 36 publications

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“…A pesar de estos avances importantes, el bloqueo neuromuscular residual (BNMR) sigue siendo un problema frecuente y muchas veces no detectado en las unidades de recuperación postanestésica (URPA) 2 , lo cual puede incrementar la morbilidad durante el postoperatorio inmediato 3 .…”

Section: íNdice Generalunclassified

“…La monitorización objetiva del BNM durante el periodo perioperatorio, la elección del relajante muscular, la utilización de un grado de bloqueo ajustado al tipo de cirugía y a las necesidades individuales del paciente en el transcurso de la anestesia general, y la reversión adecuada del bloqueo al final de la intervención son las estrategias que puede emplear el anestesiólogo para reducir el riesgo de bloqueo residual 36,72,83 .…”

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Monitorización intraoperatoria del bloqueo neuromuscular y la presión arterial con un solo dispositivo (TOF-Cuff): estudio comparativo con la mecanomiografía y la presión arterial invasiva

Ruiz

Cayuela

Montes

et al. 2017

Revista Española de Anestesiología y Reanimación

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Section: íNdice Generalunclassified

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Monitorización intraoperatoria del bloqueo neuromuscular y la presión arterial con un solo dispositivo (TOF-Cuff): estudio comparativo con la mecanomiografía y la presión arterial invasiva

Ruiz

Cayuela

Montes

et al. 2017

Revista Española de Anestesiología y Reanimación

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“…In the same institution, the incidence of desaturation to\90% was found to be 21% in a prospective study in which all patients had conventional nerve stimulators. 17 This highlights the wide discrepancy that can be observed between studies depending on the primary outcome. A greater incidence is more likely in prospective studies in which data collection is more complete.…”

Section: Incidence Of Complicationsmentioning

confidence: 99%

“…19 As with any clinical situation, monitoring data have to be interpreted, and information from different sources has to be available. In some studies, the presence of quantitative monitors has been shown to decrease the incidence of residual paralysis, 17 but this does not make qualitative monitors obsolete.…”

Section: Quantitative Monitoringmentioning

confidence: 99%

“…Dans le même établissement, on a observé, au cours d'une étude prospective portant sur des patients monitorés à l'aide de neurostimulateurs conventionnels, une incidence de 21 % de désaturation à \ 90 %. 17 Cet exemple souligne les écarts considérables qui peuvent être observés d'une étude à une autre selon le critère d'évaluation principal. Une incidence plus élevée est plus probable dans les études prospectives dans lesquelles la collecte de données est plus exhaustive.…”

Section: Residual Paralysis 723unclassified

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Residual paralysis: a real problem or did we invent a new disease?

Donati

2013

Can J Anesth/J Can Anesth

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Purpose Over the past three decades, many studies have shown a high proportion of patients in the recovery room with residual neuromuscular blockade after anesthesia. The purpose of this Continuing Professional Development module is to present the physiological consequences of residual paralysis, estimate the extent of the problem, and suggest solutions to prevent its occurrence. Principal findings Residual paralysis is defined as a train-of-four ratio (TOFR) \ 0.9 at the adductor pollicis. While tidal volume and, to a lesser extent, vital capacity are well preserved as the intensity of blockade increases, the probability of airway obstruction, impaired swallowing, and pulmonary aspiration increases markedly as TOFR decreases. In recent studies, incidences of residual paralysis from 4-57% have been reported, but surveys indicate that anesthesiologists estimate the incidence of the problem at 1% or less. The decision to administer neostigmine or sugammadex should be based on the degree of spontaneous recovery at the adductor pollicis muscle (thumb), not on recovery at the corrugator supercilii (eyebrow). The most important drawback of neostigmine is its inability to reverse profound blockade, which is a consequence of its ceiling effect. When spontaneous recovery reaches the point where TOFR [ 0.4 or four equal twitch responses are seen, reduced doses of neostigmine may be given. The dose of sugammadex required in a given situation depends on the intensity of blockade. Conclusion Careful monitoring and delaying the administration of neostigmine until four twitches are observed at the adductor pollicis can decrease the incidence of residual paralysis. The clinical and pharmacoeconomic effects of unrestricted sugammadex use are unknown at this time. ObjectivesAfter reading this module, the reader should be able to:1. Describe the physiological effects of residual neuromuscular blockade 2. Define and justify the current threshold used for residual paralysis 3. Interpret the information provided by qualitative and quantitative monitors 4. Decide the dose and timing of administration of neostigmine 5. Manage neuromuscular blockade and reversal during and after anesthesia.In 1979, Viby-Mogensen et al. 1 reported that 42% of patients receiving non-depolarizing neuromuscular blocking agents during anesthesia followed by neostigmine at the end of the procedure had neuromuscular weakness in the recovery room, as documented by a train-of-four ratio 123Can J Anesth/J Can Anesth (2013) 60:714-729 DOI 10.1007 (TOFR) \ 0.7. This first description of what was later termed residual paralysis, residual curarization, or postoperative residual curarization was followed by many other observations in many countries around the world and in different settings. The introduction of shorter-acting agents, such as vecuronium and atracurium and later rocuronium and cisatracurium, to replace the longer-acting agents available in 1979 led to a decrease in the incidence of residual paralysis. 2 Nevertheless, many lines of evidence now...

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Neuromuscular Blockade

Martin‐Flores¹,

Basher²

2023

Advanced Monitoring and Procedures for Small Animal Emergency and Critical Care

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Intraoperative Acceleromyographic Monitoring Reduces the Risk of Residual Neuromuscular Blockade and Adverse Respiratory Events in the Postanesthesia Care Unit

Abstract: Incomplete neuromuscular recovery can be minimized with acceleromyographic monitoring. The risk of adverse respiratory events during early recovery from anesthesia can be reduced by intraoperative acceleromyography use.

Cited by 283 publications

References 36 publications

Monitorización intraoperatoria del bloqueo neuromuscular y la presión arterial con un solo dispositivo (TOF-Cuff): estudio comparativo con la mecanomiografía y la presión arterial invasiva

Monitorización intraoperatoria del bloqueo neuromuscular y la presión arterial con un solo dispositivo (TOF-Cuff): estudio comparativo con la mecanomiografía y la presión arterial invasiva

Residual paralysis: a real problem or did we invent a new disease?

Neuromuscular Blockade

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