Residual neuromuscular block as a risk factor for critical respiratory events in the post anesthesia care unit

Norton, Maria C.; Xará, Daniela; Parente, D.; Barbosa, M.; Abelha, Fernando

doi:10.1016/j.redar.2012.12.011

Cited by 30 publications

(19 citation statements)

References 29 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Despite advances in the neuromuscular monitoring methods and pharmacological agents used in anaesthesia practice, the ndings of this study showed that postoperative CREs were signi cantly associated with RNMB (P=0.001), which was consistent with the previous studies (Grosse-Sundrup et al 2012;Murphy et al 2008a;Murphy et al 2008b;Norton et al 2013;Sauer et al 2011) as shown in table 5. Murphy et al (2008b) in their study which has examined the effectiveness of quantitative (acceleromyography) and qualitative neuromuscular monitoring in reducing the incidence of RNMB after tracheal extubation.…”

Section: Discussionsupporting

confidence: 91%

The Association Between Residual Neuromuscular Blockade (Rnmb) and Critical Respiratory Events: A Prospective Cohort Study

Alenezi

Alnababtah

Alqahtani

et al. 2020

Preprint

View full text Add to dashboard Cite

Abstract Background: Inadequate neuromuscular recovery might impair pulmonary function among adult patients who undergo general anaesthesia and might thus contribute to critical respiratory events in the post-anaesthesia care unit (PACU). The aim of this study to investigate whether critical respiratory events (CREs) that described in a modified Murphy’s criteria are significantly associated with residual neuromuscular blockade (RNMB).Method: A prospective cohort study from January to March 2017 from a tertiary hospital from Saudi Arabia for thirty adult patients over 18 years old scheduled for elective surgery under general anaesthesia with neuromuscular blocking drugs (NMBDs) were enrolled in the study. The Mann-Whitney U tests, Chi-Square tests and Independent-Samples T tests were used. The Train-of-four (TOF) ratios were measured upon arrival in the PACU by using Acceleromyography with TOF-Scan. Subjects’ demographics, perioperative data, and the occurrence of postoperative CREs in the PACU were recorded. Results: 26 (86.7%) patients out of thirty in the study has received Rocuronium as NMBDs while Neostigmine as a reversal drug with only 23 (76.7%). The incidence of RNMB (TOF ratio < 0.9) was in 16 patients (53.3%). The incidence of RNMB was significantly higher in female patients (p= 0.033), in patients who had not undergone quantitative neuromuscular monitoring before extubation (p= 0.046) and in patients with shorter duration of surgery (p= 0.001). Postoperative CREs occurred in twenty patients (66.7%), and there were significantly more of these CREs among patients with RNMB (P= 0.001). In addition, a statistically significant difference was observed in the occurrence of CREs according to body mass index (P= 0.047). Conclusion: This research showed that RNMB is a significant contributing factor to the development of critical respiratory events during PACU stay. Therefore, routine quantitative neuromuscular monitoring is recommended to reduce the incidence of RNMB.

show abstract

Section: Discussionsupporting

confidence: 91%

The Association Between Residual Neuromuscular Blockade (Rnmb) and Critical Respiratory Events: A Prospective Cohort Study

Alenezi

Alnababtah

Alqahtani

et al. 2020

Preprint

View full text Add to dashboard Cite

show abstract

“…, Norton et al . ); in the rest, oxygen administration was left at the discretion of PACU nurses. In all studies, RNB was quantitatively assessed, by the use of acceleromyography or mechanomyography.…”

Section: Resultsmentioning

confidence: 99%

Residual neuromuscular blockade and postoperative critical respiratory events: literature review

Kiekkas

Bakalis

Stefanopoulos

et al. 2014

Journal of Clinical Nursing

View full text Add to dashboard Cite

show abstract

“…For procedures ending with moderate neuromuscular block, when patients are not verified to have full neuromuscular recovery (TOF ratio ≥ 0.9) prior to extubation in the OR, use of neostigmine results in a high incidence of RNMB [6], with associated clinical complications of upper airway obstruction and hypoxemia [32, 33]. To avoid these risks of respiratory complications, if patients administered neostigmine are maintained in the OR until full neuromuscular recovery is verified and they may be safely extubated, additional time is expended within the OR [13, 16].…”

Section: Discussionmentioning

confidence: 99%

A discrete event simulation model of clinical and operating room efficiency outcomes of sugammadex versus neostigmine for neuromuscular block reversal in Canada

Insinga

Joyal²,

Goyette³

et al. 2016

BMC Anesthesiol

View full text Add to dashboard Cite

BackgroundThe objective of this analysis is to explore potential impact on operating room (OR) efficiency and incidence of residual neuromuscular blockade (RNMB) with use of sugammadex (Bridion™, Merck & Co., Inc., Kenilworth, NJ USA) versus neostigmine for neuromuscular block reversal in Canada.MethodsA discrete event simulation (DES) model was developed to compare ORs using either neostigmine or sugammadex for NMB reversal over one month. Selected inputs included OR procedure and turnover times, hospital policies for paid staff overtime and procedural cancellations due to OR time over-run, and reductions in RNMB and associated complications with sugammadex use. Trials show sugammadex’s impact on OR time and RNMB varies by whether full neuromuscular recovery (train-of-four ratio ≥0.9) is verified prior to extubation in the OR. Scenarios were therefore evaluated reflecting varied assumptions for neuromuscular reversal practices.ResultsWith use of moderate neuromuscular block, when full neuromuscular recovery is verified prior to extubation (93 procedures performed with sugammadex, 91 with neostigmine), use of sugammadex versus neostigmine avoided 2.4 procedural cancellations due to OR time over-run and 33.5 h of paid staff overtime, while saving an average of 62 min per OR day. No difference was observed between comparators for these endpoints in the scenario when full neuromuscular recovery was not verified prior to extubation, however, per procedure risk of RNMB at extubation was reduced from 60% to 4% (reflecting 51 cases prevented), with associated reductions in risks of hypoxemia (12 cases avoided) and upper airway obstruction (23 cases avoided).Sugammadex impact in reversing deep neuromuscular block was evaluated in an exploratory analysis. When it was hypothetically assumed that 30 min of OR time were saved per procedure, the number of paid hours of staff over-time dropped from 84.1 to 32.0, with a 93% reduction in the per patient risk of residual blockade.ConclusionsIn clinical practice within Canada, for the majority of patients currently managed with moderate neuromuscular block, the principal impact of substituting sugammadex for neostigmine is likely to be a reduction in the risk of residual blockade and associated complications. For patients maintained at a deep level of block to the end of the procedure, sugammadex is likely to both enhance OR efficiency and reduce residual block complications.Electronic supplementary materialThe online version of this article (doi:10.1186/s12871-016-0281-3) contains supplementary material, which is available to authorized users.

show abstract

Residual neuromuscular block as a risk factor for critical respiratory events in the post anesthesia care unit

Cited by 30 publications

References 29 publications

The Association Between Residual Neuromuscular Blockade (Rnmb) and Critical Respiratory Events: A Prospective Cohort Study

The Association Between Residual Neuromuscular Blockade (Rnmb) and Critical Respiratory Events: A Prospective Cohort Study

Residual neuromuscular blockade and postoperative critical respiratory events: literature review

A discrete event simulation model of clinical and operating room efficiency outcomes of sugammadex versus neostigmine for neuromuscular block reversal in Canada

Contact Info

Product

Resources

About