Postoperative Residual Curarisation: Incidence, Aetiology and Associated Morbidity

Abstract

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.

A comparison of sugammadex and neostigmine for reversal of rocuronium‐induced neuromuscular blockade in children

“…The current trial was registered with Pan African Clinical Trials Registry (PACTR201511001296403) before enrollment of the participants. Exclusion criteria included body mass index more than 40 kg/m, kidney or liver disease, history of neuromuscular disease or malignant hyperthermia, mental retardation and hypersensitivity to any of the study drugs. Patients were randomly divided into two equal groups (30 patients each) to receive sugammadex (Group S) or neostigmine (Group N) as a reversal drug for rocuronium at the end of surgery.…”

“…They can be categorised as depolarising (succinylcholine) and non‐depolarising (steroid‐based and benzylisoquinoline) muscle relaxants. Although non‐depolarising muscle relaxants have very few adverse effects (mostly allergic reactions), a residual duration of action of muscle relaxants beyond the end of surgery, also referred to as post‐operative residual curarisation (PORC) is a well‐known problem . Cholinesterase inhibitors are traditionally used for reversal of neuromuscular blockade (NMB).…”

Antagonism of non‐depolarising neuromuscular block: current practice

“…However, good outcome studies remain difficult to conduct. As pointed out by Shorten [53], several factors work against obtaining reliable information. First, it is unlikely that most postoperative complications can be attributed to a single cause.…”

Which muscle relaxants should be used in day surgery and when

“…Recent data and editorials warning about PORC have made residual curarization one of the most feared complications in anaesthesia [35][36][37][38][39]40 ] and quantitative NMT measurement is presently considered the only recommended method to diagnose residual block [41].…”