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Usefulness of intra-operative neuromuscular blockade monitoring and reversal agents for postoperative residual neuromuscular blockade: a retrospective observational study.
BMC Anesthesiol 2019; 19(1):143BA

Abstract

BACKGROUND

Complete avoidance of residual neuromuscular blockade (RNMB) during the postoperative period has not yet been achieved in current anesthesia practice. Evidently, compliance with NMB monitoring is persistently low, and the risk of RNMB during the perioperative period remains underestimated. To our knowledge, no publications have reported the incidence of RNMB in a university hospital where access to quantitative NMB monitoring and sugammadex is unlimited and where NMB management is not protocolised. The primary aim of this study was to estimate the incidence of RNMB in patients managed with or without sugammadex or neostigmine as antagonists and quantitative NMB monitoring in the operating room. The secondary aim was to explore the associations between RNMB and potentially related variables.

METHODS

This retrospective observational cohort study was conducted at a tertiary referral university hospital in Buenos Aires, Argentina. Records created between June 2015 and December 2015 were reviewed. In total, 240 consecutive patients who had undergone elective surgical procedures requiring NMB were included. All patients were monitored via acceleromyography at the adductor pollicis muscle within 5 min of arrival in the postanaesthesia care unit (PACU). Scheduled recovery in the intensive care unit was the only exclusion criterion.

RESULTS

RNMB was present in 1.6% patients who received intra-operative quantitative NMB monitoring and 32% patients whose NMB was not monitored (P < 0.01). Multivariable analysis revealed that the use of intra-operative quantitative NMB monitoring and sugammadex were associated with a lower incidence of RNMB, with calculated odds ratios of 0.04 (95% confidence interval [CI]: 0.005 to 0.401) and 0.18 (95% CI: 0.046 to 0.727), respectively.

CONCLUSIONS

The results of the present study suggest that intra-operative quantitative NMB monitoring and use of sugammadex are associated with a decreased incidence of RNMB in the PACU, reinforcing the contention that the optimal strategy for RNMB avoidance is the use of quantitative NMB monitoring and eventual use of reversal agents, if needed, prior to emergence from anaesthesia.

Authors+Show Affiliations

Department of Anesthesiology, Italiano de Buenos Aires Hospital, Presidente Teniente General Juan Domingo Perón 4190, Postal Code, 1199, Buenos Aires, Argentina. gonzalo.domenech@hospitalitaliano.org.ar.Department of Anesthesiology, Italiano de Buenos Aires Hospital, Presidente Teniente General Juan Domingo Perón 4190, Postal Code, 1199, Buenos Aires, Argentina.Department of Anesthesiology, Italiano de Buenos Aires Hospital, Presidente Teniente General Juan Domingo Perón 4190, Postal Code, 1199, Buenos Aires, Argentina.Department of Anesthesiology, Italiano de Buenos Aires Hospital, Presidente Teniente General Juan Domingo Perón 4190, Postal Code, 1199, Buenos Aires, Argentina.Department of Research, Italiano de Buenos Aires Hospital, Buenos Aires, Argentina.Department of Anesthesiology, Italiano de Buenos Aires Hospital, Presidente Teniente General Juan Domingo Perón 4190, Postal Code, 1199, Buenos Aires, Argentina.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31390986

Citation

Domenech, Gonzalo, et al. "Usefulness of Intra-operative Neuromuscular Blockade Monitoring and Reversal Agents for Postoperative Residual Neuromuscular Blockade: a Retrospective Observational Study." BMC Anesthesiology, vol. 19, no. 1, 2019, p. 143.
Domenech G, Kampel MA, García Guzzo ME, et al. Usefulness of intra-operative neuromuscular blockade monitoring and reversal agents for postoperative residual neuromuscular blockade: a retrospective observational study. BMC Anesthesiol. 2019;19(1):143.
Domenech, G., Kampel, M. A., García Guzzo, M. E., Novas, D. S., Terrasa, S. A., & Fornari, G. G. (2019). Usefulness of intra-operative neuromuscular blockade monitoring and reversal agents for postoperative residual neuromuscular blockade: a retrospective observational study. BMC Anesthesiology, 19(1), p. 143. doi:10.1186/s12871-019-0817-4.
Domenech G, et al. Usefulness of Intra-operative Neuromuscular Blockade Monitoring and Reversal Agents for Postoperative Residual Neuromuscular Blockade: a Retrospective Observational Study. BMC Anesthesiol. 2019 Aug 7;19(1):143. PubMed PMID: 31390986.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Usefulness of intra-operative neuromuscular blockade monitoring and reversal agents for postoperative residual neuromuscular blockade: a retrospective observational study. AU - Domenech,Gonzalo, AU - Kampel,Matías A, AU - García Guzzo,María E, AU - Novas,Delfina Sánchez, AU - Terrasa,Sergio A, AU - Fornari,Gustavo Garcia, Y1 - 2019/08/07/ PY - 2019/04/27/received PY - 2019/07/29/accepted PY - 2019/8/9/entrez PY - 2019/8/9/pubmed PY - 2019/8/9/medline KW - Neuromuscular blockade KW - Neuromuscular blockade monitoring KW - Residual neuromuscular blockade SP - 143 EP - 143 JF - BMC anesthesiology JO - BMC Anesthesiol VL - 19 IS - 1 N2 - BACKGROUND: Complete avoidance of residual neuromuscular blockade (RNMB) during the postoperative period has not yet been achieved in current anesthesia practice. Evidently, compliance with NMB monitoring is persistently low, and the risk of RNMB during the perioperative period remains underestimated. To our knowledge, no publications have reported the incidence of RNMB in a university hospital where access to quantitative NMB monitoring and sugammadex is unlimited and where NMB management is not protocolised. The primary aim of this study was to estimate the incidence of RNMB in patients managed with or without sugammadex or neostigmine as antagonists and quantitative NMB monitoring in the operating room. The secondary aim was to explore the associations between RNMB and potentially related variables. METHODS: This retrospective observational cohort study was conducted at a tertiary referral university hospital in Buenos Aires, Argentina. Records created between June 2015 and December 2015 were reviewed. In total, 240 consecutive patients who had undergone elective surgical procedures requiring NMB were included. All patients were monitored via acceleromyography at the adductor pollicis muscle within 5 min of arrival in the postanaesthesia care unit (PACU). Scheduled recovery in the intensive care unit was the only exclusion criterion. RESULTS: RNMB was present in 1.6% patients who received intra-operative quantitative NMB monitoring and 32% patients whose NMB was not monitored (P < 0.01). Multivariable analysis revealed that the use of intra-operative quantitative NMB monitoring and sugammadex were associated with a lower incidence of RNMB, with calculated odds ratios of 0.04 (95% confidence interval [CI]: 0.005 to 0.401) and 0.18 (95% CI: 0.046 to 0.727), respectively. CONCLUSIONS: The results of the present study suggest that intra-operative quantitative NMB monitoring and use of sugammadex are associated with a decreased incidence of RNMB in the PACU, reinforcing the contention that the optimal strategy for RNMB avoidance is the use of quantitative NMB monitoring and eventual use of reversal agents, if needed, prior to emergence from anaesthesia. SN - 1471-2253 UR - https://www.unboundmedicine.com/medline/citation/31390986/Usefulness_of_intra-operative_neuromuscular_blockade_monitoring_and_reversal_agents_for_postoperative_residual_neuromuscular_blockade:_a_retrospective_observational_study L2 - https://bmcanesthesiol.biomedcentral.com/articles/10.1186/s12871-019-0817-4 DB - PRIME DP - Unbound Medicine ER -