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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
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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
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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
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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
pearl
1
Intubation using propofol and remifentanil without muscle relaxant is associated with a greater incidence of poor intubating conditions.
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
pearl
1
Intubation without muscle relaxant is associated with greater incidence of sore throat, hoarseness, hypotension, bradycardia and intubation difficulty.
Combes X, Andriamifidy L, Dufresne E et al. Comparison of two induction regimens using or not using muscle relaxant: impact on postoperative upper airway discomfort. Br J Anaesth. 2007 Aug 1;99(2):276-81.
  Daniel Jolley
comment
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Make sure to read the editorial in the same issue from Schneider, Restrict relaxants, be aware, and know the limitations of your depth of anaesthesia monitor, and a related study from back in 2003 from Messner, The bispectral index declines during neuromuscular block in fully awake persons.
Schuller PJ, Newell S, Strickland PA et al. Response of bispectral index to neuromuscular block in awake volunteers†. Br J Anaesth. 2015 Jul 1;115 Suppl 1:i95-i103.
  Daniel Jolley