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Anesthesiol Res Pract · Jan 2015
Postoperative Residual Neuromuscular Paralysis at an Australian Tertiary Children's Hospital.
This small (N=64) post-operative audit of children receiving muscle relaxants in an Australian tertiary paediatric hospital identified a 28% incidence of post-operative residual paralysis, measured immediately before extubation.
Worryingly, the incidence of residual paralysis was even higher in the subgroup reversed with neostigmine (38%), which the authors attribute to anaesthetists not waiting long enough after administration.
Severe residual paralysis (TOFR < 0.7) was observed in 7% of cases.
Only 23% of anaesthetists used intra-operative neuromuscular monitoring.
summary- Thomas Ledowski, Brendan O'Dea, Luke Meyerkort, Mary Hegarty, and Britta S von Ungern-Sternberg.
- School of Medicine and Pharmacology, University of Western Australia, Perth 6009, WA, Australia ; Department of Anaesthesia and Pain Medicine, Royal Perth Hospital, Perth 6000, WA, Australia.
- Anesthesiol Res Pract. 2015 Jan 1;2015:410248.
AbstractPurpose. Residual neuromuscular blockade (RNMB) is known to be a significant but frequently overlooked complication after the use of neuromuscular blocking agents (NMBA). Aim of this prospective audit was to investigate the incidence and severity of RNMB at our Australian tertiary pediatric center. Methods. All children receiving NMBA during anesthesia were included over a 5-week period at the end of 2011 (Mondays to Fridays; 8 a.m.-6 p.m.). At the end of surgery, directly prior to tracheal extubation, the train-of-four (TOF) ratio was assessed quantitatively. Data related to patient postoperative outcome was collected in the postoperative acute care unit. Results. Data of 64 patients were analyzed. Neostigmine was given in 34 cases and sugammadex in 1 patient. The incidence of RNMB was 28.1% overall (without reversal: 19.4%; after neostigmine: 37.5%; n.s.). Severe RNMB (TOF ratio < 0.7) was found in 6.5% after both no reversal and neostigmine, respectively. Complications in the postoperative acute care unit were infrequent, with no differences between reversal and no reversal groups. Conclusions. In this audit, RNMB was frequently observed, particularly in cases where patients were reversed with neostigmine. These findings underline the well-known problems associated with the use of NMBA that are not fully reversed.
This article appears in the collection: Neuromuscular myths: the lies we tell ourselves.
Notes
This small (N=64) post-operative audit of children receiving muscle relaxants in an Australian tertiary paediatric hospital identified a 28% incidence of post-operative residual paralysis, measured immediately before extubation.
Worryingly, the incidence of residual paralysis was even higher in the subgroup reversed with neostigmine (38%), which the authors attribute to anaesthetists not waiting long enough after administration.
Severe residual paralysis (TOFR < 0.7) was observed in 7% of cases.
Only 23% of anaesthetists used intra-operative neuromuscular monitoring.
Daniel Jolley
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