Residual Paralysis in the PACU after a Single Intubating Dose of Nondepolarizing Muscle Relaxant with an Intermediate Duration of Action
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- 1 May 2003
- journal article
- research article
- Published by Wolters Kluwer Health in Anesthesiology
- Vol. 98 (5), 1042-1048
- https://doi.org/10.1097/00000542-200305000-00004
Abstract
Residual neuromuscular blockade remains a problem even after short surgical procedures. The train-of-four (TOF) ratio at the adductor pollicis required to avoid residual paralysis is now considered to be at least 0.9. The incidence of residual paralysis using this new threshold is not known, especially after a single intubating dose of intermediate-duration nondepolarizing relaxant. Therefore, the aim of the study was to determine the incidence of residual paralysis in the postanesthesia care unit after a single intubating dose of twice the ED95 of a nondepolarizing muscle relaxant with an intermediate duration of action. Five hundred twenty-six patients were enrolled. They received a single dose of vecuronium, rocuronium, or atracurium to facilitate tracheal intubation and received no more relaxant thereafter. Neuromuscular blockade was not reversed at the end of the procedure. On arrival in the postanesthesia care unit, the TOF ratio was measured at the adductor pollicis, using acceleromyography. Head lift, tongue depressor test, and manual assessment of TOF and DBS fade were also performed. The time delay between the injection of muscle relaxant and quantitative measurement of neuromuscular blockade was calculated from computerized anesthetic records. The TOF ratios less than 0.7 and 0.9 were observed in 16% and 45% of the patients, respectively. Two hundred thirty-nine patients were tested 2 h or more after the administration of the muscle relaxant. Ten percent of these patients had a TOF ratio less than 0.7, and 37% had a TOF ratio less than 0.9. Clinical tests (head lift and tongue depressor) and manual assessment of fade showed a poor sensitivity (11–14%) to detect residual blockade (TOF < 0.9). After a single dose of intermediate-duration muscle relaxant and no reversal, residual paralysis is common, even more than 2 h after the administration of muscle relaxant. Quantitative measurement of neuromuscular transmission is the only recommended method to diagnose residual block.Keywords
This publication has 16 references indexed in Scilit:
- Postoperative muscle paralysis after rocuronium: less residual block when acceleromyography is usedActa Anaesthesiologica Scandinavica, 2002
- Postoperative residual block after intermediate‐acting neuromuscular blocking drugsAnaesthesia, 2001
- Postoperative residual curarization and evidence-based anaesthesiaBritish Journal of Anaesthesia, 2000
- Functional Assessment of the Pharynx at Rest and during Swallowing in Partially Paralyzed HumansAnesthesiology, 1997
- Good Clinical Research Practice (GCRP) in pharmacodynamic studies of neuromuscular blocking agentsActa Anaesthesiologica Scandinavica, 1996
- Monitoring the Onset of Neuromuscular Block at the Orbicularis Oculi Can Predict Good Intubating Conditions During Atracurium-Induced Neuromuscular BlockAnesthesia & Analgesia, 1995
- Postoperative Neuromuscular BlockadeAnesthesiology, 1988
- Residual curarisation: a comparative study of atracurium and pancuroniumActa Anaesthesiologica Scandinavica, 1988
- Residual Curarization in the Recovery RoomAnesthesiology, 1979
- THE EFFECT OF TUBOCURARINE ON INDIRECTLY ELICITED TRAIN-OF-FOUR MUSCLE RESPONSE AND RESPIRATORY MEASUREMENTS IN HUMANSBritish Journal of Anaesthesia, 1975