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pearl
1
Quantitative neuromuscular monitoring reduces the incidence of post-operative residual paralysis, desaturation and airway obstruction.
Murphy GS, Szokol JW, Marymont JH et al. Intraoperative acceleromyographic monitoring reduces the risk of residual neuromuscular blockade and adverse respiratory events in the postanesthesia care unit. Anesthesiology. 2008 Sep 1;109(3):389-98.
  Daniel Jolley
pearl
1
Intrathecal magnesium extends analgesic duration of spinal opioids.
Pascual-Ramírez J, Gil-Trujillo S, Alcantarilla C. Intrathecal magnesium as analgesic adjuvant for spinal anesthesia: a meta-analysis of randomized trials. Minerva Anestesiol. 2013 Jun 1;79(6):667-78.
  Daniel Jolley
pearl
1
Residual post-operative paralysis is as common in children as in adults after receiving neuromuscular blocking drugs.
Ledowski T, O'Dea B, Meyerkort L et al. Postoperative Residual Neuromuscular Paralysis at an Australian Tertiary Children's Hospital. Anesthesiol Res Pract. 2015 Jan 1;2015:410248.
  Daniel Jolley
comment
0
This is a great review to start with, providing a good overview of many of the myths regarding the use of neuromuscular blocking drugs that are still widely believed and practised by the global anaesthesia community.
All five of Fink & Hollman's 'myths' still hold today after reviewing the latest research in these areas.
Fink H Hollmann MW. Myths and facts in neuromuscular pharmacology. New developments in reversing neuromuscular blockade. Minerva Anestesiol. 2012 Apr 1;78(4):473-82.
  Daniel Jolley
pearl
1
Most anaesthetists and anesthesiologists incorrectly estimate the incidence of post-operative residual paralysis to be less than 1%.
Naguib M, Kopman AF, Lien CA et al. A survey of current management of neuromuscular block in the United States and Europe. Anesth. Analg. 2010 Jul 1;111(1):110-9.
  Daniel Jolley
pearl
1
After repeated rocuronium administration there is wide inter-patient variability in the time to recover muscle function.
Maybauer DM, Geldner G, Blobner M et al. Incidence and duration of residual paralysis at the end of surgery after multiple administrations of cisatracurium and rocuronium. Anaesthesia. 2007 Jan 1;62(1):12-7.
  Daniel Jolley
pearl
0
There exists a wide range of inter-patient variability for modern, intermediate-duration muscle relaxants.
Debaene B, Plaud B, Dilly MP et al. Residual paralysis in the PACU after a single intubating dose of nondepolarizing muscle relaxant with an intermediate duration of action. Anesthesiology. 2003 May 1;98(5):1042-8.
  Daniel Jolley
pearl
1
Post-operative residual paralysis is common.
Debaene B, Plaud B, Dilly MP et al. Residual paralysis in the PACU after a single intubating dose of nondepolarizing muscle relaxant with an intermediate duration of action. Anesthesiology. 2003 May 1;98(5):1042-8.
  Daniel Jolley
pearl
1
Addition of rocuronium for intubation improves intubating conditions compared with propofol and remifentanil alone.
Mencke T, Jacobs RM, Machmueller S et al. Intubating conditions and side effects of propofol, remifentanil and sevoflurane compared with propofol, remifentanil and rocuronium: a randomised, prospective, clinical trial. BMC Anesthesiol. 2014 Jan 1; 14: 39.
  Daniel Jolley
comment
0
Unfortunately the researchers did not investigate incidence of post-operative pharyngeal symptoms, such as hoarseness or sore throat.
Schlaich N, Mertzlufft F, Soltész S et al. Remifentanil and propofol without muscle relaxants or with different doses of rocuronium for tracheal intubation in outpatient anaesthesia. Acta Anaesthesiol Scand. 2000 Jul 1;44(6):720-6.
  Daniel Jolley