Pasic E, Castorena-Arellano G, Calderón-Vidal M

Language: English
References: 12
Page: 270-273
PDF size: 79.23 Kb.

ABSTRACT

Background: Several studies have shown that neuromuscular block often persists in the recovery room even after the administration of acetyl cholinesterase inhibitors. This postoperative residual neuromuscular paralysis (PORP) may represent serious safety concerns, resulting in respiratory events like muscle weakness, desaturation, pulmonary collapse and acute respiratory failure. Methods: We studied 50 patients who underwent general anesthesia and where the neuromuscular blocking agent was used, in order to determine the incidence of PORP in our institution. Results: The incidence of PORP at our hospital was of 14% (seven out of fifty patients presented train of four ‹ 0.7). The group most frequently associated with PORP was the group that received rocuronium. Surprisingly the use of neuromuscular monitoring both in the operating room and the recovery room remains very limited. Conclusions: Although our anesthesiologists are aware of mechanism of action and secure doses of neuromuscular blocking drug (NMBD), we still found presence of residual paralysis in our hospital. Given that PORP is a potentially preventable patient safety problem, it is important to find ways to reduce its incidence.

REFERENCES

1. Murphy GS, Szokol JW, Marymont JH, Greenberg SB, Avram MJ, Vender JS. Residual neuromuscular blockade and critical respiratory events in the post anesthesia care unit. Anesth Analg 2008;107:130-7.

2. Naguib M, Flood P, McArdle JJ, Brenner HR. Advances in neurobiology of the neuromuscular junction: implications for the anesthesiologist. Anesthesiology 2002;96:202-231.

3. Martyn JA. Basic and clinical pharmacology of the acetylcholine receptor: implications for the use of neuromuscular relaxants. Keio J Med 1995;44:1-8.

4. Baillard C, Clec’h C, Catineau J, et al. Postoperative residual neuromuscular block: a survey of management. Br J Anaesth 2005;95:622-6.

5. Brull SJ, Naguib M, Miller RD. Residual neuromuscular block: rediscovering the obvious. Anesth Analg 2008;107:11-4.

6. Naguib M, Kopman F, Hunter J, López A. A survey of current management of neuromuscular block in the United States and Europe. Anesth Analg 2009;10:1-11.

7. Hayes AH, Mirakhur RK, Breslin DS, Reid JE, McCourt KC. Postoperative residual block after intermediate-acting neuromuscular blocking drugs. Anaesthesia 2001;56:312-8.

8. Naguib M, Kopman AF, Ensor JE. Neuromuscular monitoring and postoperative residual curarization. Br J Anaesth 2007;99:297-9.

9. Viby-Mogensen J, Engbaek J, Eriksson LI, Gramstad L, Jensen E, Jensen FS, Kooscielniak-Nielsen Z, Skovgaard LT, Ostergaard D. Good clinical research practice (GCRP) in pharmacodynamic studies of neuromuscular blocking agents. Acta Anaesthesiol Scand 1996;40:59-73.

10. Naguib M, Brull SJ. Sugammadex: a novel selective relaxant binding agent. Expert Rev Clin Pharmacol 2009;2:37-53.

11. Thompson DO. Cyclodextrins–enabling excipients: their present and future use in pharmaceuticals. Crit Rev Ther Drug Carrier Syst 1997;14:1-104.

12. Nava-Ocampo AA, Ramírez-Mora JC, Moyao-García D, Garduño-Espinosa J, Salmerón J. Preferences of Mexican anesthesiologists for vecuronium, rocuronium, or other neuromuscular blocking agents: a survey. BMC Anesthesiol 2002;2:2-9.