Intraoperative Monitoring of Neuromuscular Blockade

Abstract

There is a global trend of new guidelines highly recommending quantitative neuromuscular monitoring in the operating room. In fact, it is almost certain that quantitatively monitoring the depth of intraoperative muscle paralysis may permit the rational use of muscle relaxants and avoid some of the major related complications, namely postoperative pulmonary complications. A specific culture related to this issue is necessary to integrate quantitative monitoring of muscle relaxants as part of a major monitoring entity in anesthetized patients. For this purpose, it is necessary to fully understand the physiology, pharmacology and concept of monitoring as well as the choice of pharmacological reversal, including the introduction of sugammadex a decade ago.

Residual Neuromuscular Blockade and Postoperative Pulmonary Complications in the Post-anesthesia Care Unit: A Prospective Observational Study

“…RNMB, as indicated by the persistence of low TOF ratios, has been associated with various adverse events in the literature, including postoperative respiratory complications. Similar studies [ 8 - 14 ] in the past emphasize the clinical importance of RNMB detection, as its presence has been linked to factors such as age, type of neuromuscular agents used, and the choice of reversal agents. Esteves et al's study [ 8 ] highlights the importance of RNMB detection with a 5.5% incidence rate upon PACU arrival, suggesting that even a modest incidence warrants clinical attention.…”

Practice Guidelines for Monitoring Neuromuscular Blockade—Elements to Change to Increase the Quality of Anesthesiological Procedures and How to Improve the Acceleromyographic Method

“…Another limitation for the use of muscle relaxation monitoring stemmed from the belief that this method is only for high-risk patients and long-duration surgical procedures. Moreover, the authors emphasized that in many situations, the failure to use skeletal muscle relaxation monitoring devices during general anesthesia was due to ignorance of the legal implications [35][36][37][38][39].…”