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Residual neuromuscular block: lessons unlearned Part I: definitions, incidence, and adverse physiologic effects of residual neuromuscular block Murphy GS; Brull SJAnesth Analg 2010[Jul]; 111 (1): 120-8In this review, we summarize the clinical implications of residual neuromuscular block. Data suggest that residual neuromuscular block is a common complication in the postanesthesia care unit, with approximately 40% of patients exhibiting a train-of-four ratio <0.9. Volunteer studies have demonstrated that small degrees of residual paralysis (train-of-four ratios 0.7-0.9) are associated with impaired pharyngeal function and increased risk of aspiration, weakness of upper airway muscles and airway obstruction, attenuation of the hypoxic ventilatory response (approximately 30%), and unpleasant symptoms of muscle weakness. Clinical studies have also identified adverse postoperative events associated with intraoperative neuromuscular management. Large databased investigations have identified intraoperative use of muscle relaxants and residual neuromuscular block as important risk factors in anesthetic-related morbidity and mortality. Furthermore, observational and randomized clinical trials have demonstrated that incomplete neuromuscular recovery during the early postoperative period may result in acute respiratory events (hypoxemia and airway obstruction), unpleasant symptoms of muscle weakness, longer postanesthesia care unit stays, delays in tracheal extubation, and an increased risk of postoperative pulmonary complications. These recent data suggest that residual neuromuscular block is an important patient safety issue and that neuromuscular management affects postoperative outcomes.|Anesthesia Recovery Period[MESH]|Animals[MESH]|Cardiac Surgical Procedures[MESH]|Electric Stimulation[MESH]|Humans[MESH]|Hypoxia/physiopathology[MESH]|Monitoring, Physiologic[MESH]|Muscle Weakness/chemically induced/epidemiology[MESH]|Neuromuscular Blockade/*adverse effects/methods[MESH]|Pharyngeal Diseases/chemically induced/epidemiology[MESH]|Postoperative Complications/*chemically induced/*diagnosis/epidemiology[MESH]|Respiratory Insufficiency/chemically induced/epidemiology[MESH]|Respiratory Muscles/drug effects[MESH]|Terminology as Topic[MESH] |
