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summary
1
Schreiber demonstrated a 27% incidence of PORC (Post-operative Residual Curarization/Paralysis = TOF ratio <0.9) after surgery between 60 and 90 minutes long.
Schreiber JU, Mucha E, Fuchs-Buder T. Residual paralysis following a single dose of atracurium: results from a quality assurance trial. Eur J Anaesthesiol. 2010 Nov 1;27(11):993-4.
  Daniel Jolley
summary
1
This 2010 survey found that a significant proportion of both American anesthesiologists and European anaesthetists:
• Do not routinely reverse muscle relaxants (65% and 82% respectively US & EU).
• Do not have access to quantitative NMBD monitors (77% and 30%).
• Do not ever use neuromuscular monitors (9% and 19%).
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
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
summary
1
Debaene et al. investigated residual paralysis in the PACU after a single intubating dose of intermediate NMBD in the absence of reversal.
They identified PORC (Post-Operative Residual Curarization = TOFR <0.9) in 45% of patients, with 'time since NMBD' ranging from 30 to 400 minutes.
In a subgroup of patients 2 hours after a single NMBD dose there was still a 37% incidence of PORC.
Additionally there was very wide inter-patient variability, with PORC persisting more than 6 hours in three patients, and several patients with TOFR of only 0.2 after 2 hours.
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
summary
1
In 83 patients researchers compared intubation with propofol 1.5 mg/kg, remifentanil 0.30 μg/kg/min & sevoflurane 1.0 MAC to intubation with the same propofol & remifentanil dose, along with rocuronium 0.45 mg/kg.
Acceptable intubating conditions were 18% more frequent in the muscle relaxant group than in those receiving propofol/remi/sevo.
Incidence of laryngeal injury, hoarseness and sore throat was similar between the two groups - which is different to the result from an earlier, larger study of intubation without relaxant: Comparison of two induction regimens using or not using muscle relaxant: impact on postoperative upper airway discomfort.
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