Chang Gung medical journal
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Neuromuscular blocking agents (NMBAs) are widely used during the induction and maintenance of anesthesia. Postoperative residual curarization (PORC) following the use of NMBAs still occurs even though intermediate-acting NMBAs were used. Train-of-four (TOF) stimulation is used to quantify the degree of neuromuscular blockade. The TOF ratio of 0.7 in the adductor pollicis muscle was associated with normal respiratory function. Pharyngeal function returned to normal while the TOF ratio reached 0.9. The aim of this study was to survey the PORC in the post-anesthesia care unit (PACU). ⋯ PORC is still a clinical problem in the modern PACU. Objective neuromuscular monitoring needs to be performed to ensure patient safety.
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The timing of initiation of epidural analgesia and its causal relationship with mode of delivery is controversial. This retrospective investigation reviews and determines whether early initiation of epidural analgesia in nulliparous women influences the rate of cesarean sections as well as other obstetric outcome measures. ⋯ The administration of epidural analgesia with a regimen of ropivacaine and fentanyl should not be delayed until cervical dilatation reaches 3 cm in nulliparas who are in spontaneous labor or have spontaneous rupture of the membranes. The timing of epidural analgesia should be determined on an individualized basis.