Residual neuromuscular blockade and late neuromuscular blockade at the post-anesthetic recovery unit: prospective cohort study

Gonçalves, Pedro Marcos Silva e; Vieira, Alexandra de Vasconcelos; Silva, Claudia Helena Ribeiro da; Gomez, Renato Santiago

doi:10.1016/j.bjane.2020.12.009

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Brazilian Journal of Anesthesiology

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Sumário

Clinical Research • para Braz. J. Anesthesiol. 71 (1) • Jan-Feb 2021 • https://doi.org/10.1016/j.bjane.2020.12.009 copy

Residual neuromuscular blockade and late neuromuscular blockade at the post-anesthetic recovery unit: prospective cohort study

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Introduction and objectives:

The use of neuromuscular blockers during surgery represented a landmark for anesthesiology. However, their use can prompt residual Neuromuscular Blockade (_RNMB) and objective monitoring of neuromuscular function is crucial to warrant the recovery of muscle strength. The present study aimed to estimate the incidence of _RNMB and late Neuromuscular Blockade (_LNMB) at the Post-Anesthetic Recovery Unit (PACU).

Method:

The study included 85 patients, 43 of which received cisatracurium and 42 of which, rocuronium. The depth of the Neuromuscular Blockade (NMB) was assessed by Train Of Four (TOF). NMB reversal was performed with the administration of neostigmine and atropine._RNMB was defined when a patient presented TOF below 90% at the PACU.

Results:

_RNMB at the PACU was diagnosed in 39.5% and 40.5% of the patients receiving cisatracurium and rocuronium, respectively (p = 1.0). _LNMB at the PACU was found in 32.6% and 16.7% of the patients receiving cisatracurium and rocuronium, respectively (p = 0.131).

Conclusions:

The incidence of_RNMB remains significant despite the use of intermediate-acting neuromuscular blockers and reversal agents. There was no statistically significant difference in the incidence of _RNMB or _LNMB in patients receiving cisatracurium or rocuronium. The use of objective NMB monitoring is effective for the diagnosis of _RNMB, as well as for treatment management.

KEYWORDS
Neuromuscular blockers; General anesthesia; Neuromuscular monitoring; Neostigmine; Recovery unit; Postoperative complications

		Cisatracurium (n = 43)	Rocuronium (n = 42)	p
Age (years)
Mean ± SD		35.16 ± 7.208	36.76 ± 7.457	0.3176^a a Student t test.
Sex
n (%)	Male	10 (23.3%)	9 (21.4%)	1.0000^b b Fisher´s exact test.
n (%)	Female	33 (76.7%)	33 (78.6%)
Weight (kg)
Median (25 P-75 P)		72.0 (65.0-82.0)	79.2 (61.0-79.2)	0.2853^c c Mann-Whitney test.
	BMI Mean ± SD
	26.83 ± 3.57	25.87 ± 3.47	0.2169^a a Student t test.
Physical status
n (%)	ASA I	27 (62.8%)	31 (73.8%)	0.3529^b b Fisher´s exact test.
n (%)	ASA II	16 (37.2%)	11 (26.2%)

	Cisatracurium (n = 43)	Rocuronium (n = 42)
	Median (25 P-75 P)	Median (25 P-75 P)	p
Surgery total duration (minutes)	56 (41-65)	54.50 (44.50-67.75)	0.4928^a a Mann-Whitney test.
From reversal to extubation (minutes)	15.5 (13.75-18)	16 (12.5-17.5)	0.4641^a a Mann-Whitney test.
From end of surgery to extubation (minutes)	18 (15-27)	17 (14-19.25)	0.0715^a a Mann-Whitney test.
From end of surgery to PACU (minutes)	30 (25-39)	27 (24-32)	0.0523^a a Mann-Whitney test.
From extubation to PACU (minutes)	10 (7-12)	9 (7-13)	0.5781^a a Mann-Whitney test.

TOF⁽^a a TOF median values described as T4/T1 ratio percentage. ⁾	Cisatracurium (n = 43)	Rocuronium (n = 42)	p
	Median (25 P-75 P)	Median (25 P-75 P)	p
Five minutes after reversal	44.0% (23.0-74.0)	66.5% (38.0-77.0)	0.0414^b b Mann-Whitney test.
After extubation	81.0% (74.0-96.0)	89.5% (72.0-100.0)	0.6794^b b Mann-Whitney test.
On PACU admission	94.0% (83.0-106.0)	94.0% (83.0-105.0)	0.8604^b b Mann-Whitney test.

TOF below 90%	Cisatracurium	Rocuronium	p
TOF below 90%	n (%)	n (%)	p
After neuromuscular blocker ideal time	40/43 (93.0%)	42/42 (100%)	0.2412^b b Fisher´s exact test.
After discontinuation of anesthetic agents	42/43 (97.7%)	41/42 (97.6%)	1.0000^b b Fisher´s exact test.
Five minutes after reversal^a a Only patients receiving reversal drug were analyzed.	36/42 (85.7%)	35/41 (85.4%)	1.0000^b b Fisher´s exact test.
After extubation	27/43 (62.8%)	21/42 (50.0%)	0.2776^b b Fisher´s exact test.
On PACU admission	17/43 (39.5%)	17/42 (40.5%)	1.0000^b b Fisher´s exact test.

Sociedade Brasileira de Anestesiologia (SBA) Rua Professor Alfredo Gomes, 36, Botafogo , cep: 22251-080 - Rio de Janeiro - RJ / Brasil , tel: +55 (21) 97977-0024 - Rio de Janeiro - RJ - Brazil
E-mail: editor.bjan@sbahq.org

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[1] * Corresponding author. E-mail: pedro.marcoss@yahoo.com.br (P.M. Gonçalves).