Acta anaesthesiologica Scandinavica. Supplementum
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Acta Anaesthesiol Scand Suppl · Jan 1994
Adverse reaction to neuromuscular blockers: frequency, investigation, and epidemiology.
A survey is presented of neuromuscular drug involvement in 390 clinically severe anaphylactoid reactions (grades II-IV reported to a Sheffield laboratory from 1988 to the end of 1992 from hospitals throughout the UK. Despite advances in patient monitoring and newer drugs, the reporting frequency and individual drug involvement were remarkably similar to those of a previous report from the laboratory in 1988. The highly immunogenic drug suxamethonium still predominated (48% of reports), but there was now much reduced use of the similarly immunogenic drug, alcuronium. ⋯ The remaining reactions were judged to be non-immune, although most involved mast cell degranulation. These reactions were no less hazardous than Type 1 reactions (one death), and two deaths were recorded. The importance of laboratory investigation as a feature of postreaction care is emphasized.
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Ventilatory failure after administration of neuromuscular blocking agents is an important factor in anaesthesia-related perioperative morbidity and mortality. Improved knowledge and new monitoring methods may avoid ventilatory failure caused by incomplete recovery of neuromuscular function in the postoperative period. Central respiratory muscles are less sensitive than, and their time course of neuromuscular block is different from those of, pharyngeal muscles and those of the upper airway. ⋯ Hence, partial paralysis may interfere with ventilatory regulation in hypoxaemia. Consequently, monitoring neuromuscular function by peripheral nerve stimulation in one muscle yields limited information about total ventilatory capacity, especially the function of the upper airway and ventilatory regulation. Therefore, neuromuscular monitoring should be used with caution during recovery and should always be combined with bedside clinical tests if possible.