Residual Paralysis in the PACU after a Single Intubating Dose of Nondepolarizing Muscle Relaxant with an Intermediate Duration of Action

Debaene, B.; Plaud, Benoît; Dilly, Marie-Pierre; Donati, François

doi:10.1097/00000542-200305000-00004

Cited by 431 publications

(267 citation statements)

References 16 publications

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“…5,6 However, patient factors may contraindicate the use of NMBDs, and administration of NMBDs may be associated with several potentially serious complications, such as anaphylactic reactions, residual curarization (even after a single intubating dose of NMBD), and awareness during general anesthesia. [7][8][9] Moreover, high rates of good to excellent intubating conditions have been reported without the use of NMBDs, provided that the anesthetic induction protocol is optimized with an adequate dose of an opioid analgesic co-administered with either propofol or thiopental. [10][11][12][13][14][15][16] Due to its rapid onset, remifentanil 2 µg·kg -1 , combined with propofol 2 mg·kg -1 , provides acceptable intubating conditions in 75 to 85% of patients.…”

Section: Conclusion : à La Suite D'une Induction De L'anesthésie à L'mentioning

confidence: 99%

Laryngeal injuries and intubating conditions with or without muscular relaxation: an equivalence study

Bouvet

Stoian

Jacquot-Laperrière

et al. 2008

Can J Anesth/J Can Anesth

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Purpose:The need for muscular relaxation to improve intubating conditions and to reduce the incidence of laryngeal morbidity is still controversial. The aim of this study was to determine the incidence of symptomatic laryngeal injuries (SLI) and of acceptable intubating conditions (including both good and excellent conditions), both with and without cisatracurium during induction of anesthesia, along with moderate doses of remifentanil and propofol. Methods:In this prospective, randomized double-blind equivalence trial, the intubating conditions were compared in 130 ASA I or II female patients. All subjects received remifentanil 2 µg·kg -1 iv and propofol 2.5 mg·kg -1 iv, with either cisatracurium 0.15 mg·kg -1 iv (group Cisatracturium), or saline (group Placebo). Tracheal intubating conditions were assessed with the Copenhagen Score. A systematic screening for postoperative hoarseness and sore throat was performed 24 and 48 hr after anesthesia, followed by a nasofibroscopic examination when laryngeal symptoms persisted at 48 hr.Results: Twenty-four hr after anesthesia, the incidence of postoperative hoarseness and sore throat in the Cisatracurium and Placebo groups was 26.5% and 21.5%, respectively, and 48 hr after anesthesia, the incidence was 7.8% and 6.1%, respectively (P = 0.32 and P = 0.50 between groups, respectively). In the clinically evaluable population, the incidence of SLI, assessed at 48 hr by nasofibroscopy, was equivalent in both groups, 1.6% vs 1.5% in group Placebo and group Cisatracurium, respectively (P < 0.001 for equivalence test), as was the occurrence of acceptable intubating conditions (95.4% vs 100%, P < 0.05 for equivalence test). However, the occurrence of excellent intubating conditions was more frequent in group Cisatracurium than in group Placebo (P = 0.0003). Conclusion:Following induction of anesthesia with propofol and moderate-dose remifentanil, cisatracurium did not confer a higher rate of good-to-excellent conditions for tracheal intubation, nor did muscle relaxation with cisatracurium decrease the rate of SLI after tracheal intubation.

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Section: Conclusion : à La Suite D'une Induction De L'anesthésie à L'mentioning

confidence: 99%

Laryngeal injuries and intubating conditions with or without muscular relaxation: an equivalence study

Bouvet

Stoian

Jacquot-Laperrière

et al. 2008

Can J Anesth/J Can Anesth

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“…Residual neuromuscular blockade can be detected in up to 40% patients for up to two hours after their administration 35, 36. Patient harm may result from postoperative hypoxaemia in the post anaesthesia care unit 37, 38 and a risk of AAGA at extubation 13.…”

mentioning

confidence: 99%

Recommendations for standards of monitoring during anaesthesia and recovery 2015 : Association of Anaesthetists of Great Britain and Ireland

Checketts¹,

et al. 2015

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SummaryThis guideline updates and replaces the 4th edition of the AAGBI Standards of Monitoring published in 2007. The aim of this document is to provide guidance on the minimum standards for physiological monitoring of any patient undergoing anaesthesia or sedation under the care of an anaesthetist. The recommendations are primarily aimed at anaesthetists practising in the United Kingdom and Ireland. Minimum standards for monitoring patients during anaesthesia and in the recovery phase are included. There is also guidance on monitoring patients undergoing sedation and also during transfer of anaesthetised or sedated patients. There are new sections discussing the role of monitoring depth of anaesthesia, neuromuscular blockade and cardiac output. The indications for end‐tidal carbon dioxide monitoring have been updated.

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“…In studies where only one dose of intermediate acting neuromuscular blocker used for tracheal intubation and surgery duration is relatively shorter (16), anesthesia duration is determined as a risk factor for residual neuromuscular block, whereas anesthesia duration is not determined to be a risk factor in other studies (17) where surgery and anesthesia durations are relatively longer (P>0,05). It is stated that when anesthesia duration is longer and frequency of maintenance doses of neuromuscular blocking agent is increased, the risk of residual neuromuscular block increases in a dose dependent fashion (17). In our study we probably found anesthesia duration as a risk factor due to hypothermia as a consequence of cold operating rooms rather than repeating maintenance doses of neuromuscular blocking.…”

Section: Discussionmentioning

confidence: 99%

Vücut sıcaklığının orta-etkili kas gevşeticilerde rezidüel nöromüsküler blokaja etkisi

Karaarslan¹,

Gönüllü²,

Tekgül³

et al. 2016

Ege Tıp Dergisi

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Aim: Aim of this study was to compare the rates of residual neuromuscular block in patients at different postoperative body temperatures. We also investigated incidence of early postoperative residual neuromuscular block with intermediate acting neuromuscular blocking agents and the factors affecting early postoperative residual neuromuscular block with intermediate acting neuromuscular blocking agents. Material and Methods:Two hundred and sixty-eight patients who underwent surgery under general anesthesia were enrolled in this study. Patients were monitored with an acceleromyograph from the moment of admission to post anesthesia care unit. In addition to Train of Four (TOF) measurements, patients' clinical findings (tongue depressor test, hand squeezing, existence of diplopia, ability to swallow, ability to lift head and legs for 5 seconds) were monitored and recorded. Patients body temperatures are measured with a tympanic thermometer and residual neuromuscular block at different body temperatures were compared. Results:The incidence of residual neuromuscular block was 48.9%. Univariate analysis of the data showed that surgical duration, maintenance dose administration, administration of reversal agent and body temperature were significantly relevant with residual neuromuscular block. There weren't any statistically significant difference between TOF values of patients with body temperatures lower or higher than 35ºC who were administered either one of the 3 neuromuscular blocking agents utilized in this study. Conclusion:We conclude that choice of intermediate acting neuromuscular blocking agent has no influence on residual neuromuscular block in patients with both intraoperative and postoperative mild hypothermia. Keywords

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Residual Paralysis in the PACU after a Single Intubating Dose of Nondepolarizing Muscle Relaxant with an Intermediate Duration of Action

Abstract: After a single dose of intermediate-duration muscle relaxant and no reversal, residual paralysis is common, even more than 2 h after the administration of muscle relaxant. Quantitative measurement of neuromuscular transmission is the only recommended method to diagnose residual block.

Cited by 431 publications

References 16 publications

Laryngeal injuries and intubating conditions with or without muscular relaxation: an equivalence study

Laryngeal injuries and intubating conditions with or without muscular relaxation: an equivalence study

Recommendations for standards of monitoring during anaesthesia and recovery 2015 : Association of Anaesthetists of Great Britain and Ireland

Vücut sıcaklığının orta-etkili kas gevşeticilerde rezidüel nöromüsküler blokaja etkisi

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