Usefulness of intra-operative neuromuscular blockade monitoring and reversal agents for postoperative residual neuromuscular blockade: a retrospective observational study
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 under...
Main Authors: | , , , , , |
---|---|
Format: | Article |
Language: | English |
Published: |
BMC
2019-08-01
|
Series: | BMC Anesthesiology |
Subjects: | |
Online Access: | http://link.springer.com/article/10.1186/s12871-019-0817-4 |
id |
doaj-66b17140fe5e4baba8b9a03f9ed8747b |
---|---|
record_format |
Article |
spelling |
doaj-66b17140fe5e4baba8b9a03f9ed8747b2020-11-25T03:54:28ZengBMCBMC Anesthesiology1471-22532019-08-011911710.1186/s12871-019-0817-4Usefulness of intra-operative neuromuscular blockade monitoring and reversal agents for postoperative residual neuromuscular blockade: a retrospective observational studyGonzalo Domenech0Matías A. Kampel1María E. García Guzzo2Delfina Sánchez Novas3Sergio A. Terrasa4Gustavo Garcia Fornari5Department of Anesthesiology, Italiano de Buenos Aires HospitalDepartment of Anesthesiology, Italiano de Buenos Aires HospitalDepartment of Anesthesiology, Italiano de Buenos Aires HospitalDepartment of Anesthesiology, Italiano de Buenos Aires HospitalDepartment of Research, Italiano de Buenos Aires HospitalDepartment of Anesthesiology, Italiano de Buenos Aires HospitalAbstract 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.http://link.springer.com/article/10.1186/s12871-019-0817-4Neuromuscular blockadeResidual neuromuscular blockadeNeuromuscular blockade monitoring |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Gonzalo Domenech Matías A. Kampel María E. García Guzzo Delfina Sánchez Novas Sergio A. Terrasa Gustavo Garcia Fornari |
spellingShingle |
Gonzalo Domenech Matías A. Kampel María E. García Guzzo Delfina Sánchez Novas Sergio A. Terrasa Gustavo Garcia Fornari Usefulness of intra-operative neuromuscular blockade monitoring and reversal agents for postoperative residual neuromuscular blockade: a retrospective observational study BMC Anesthesiology Neuromuscular blockade Residual neuromuscular blockade Neuromuscular blockade monitoring |
author_facet |
Gonzalo Domenech Matías A. Kampel María E. García Guzzo Delfina Sánchez Novas Sergio A. Terrasa Gustavo Garcia Fornari |
author_sort |
Gonzalo Domenech |
title |
Usefulness of intra-operative neuromuscular blockade monitoring and reversal agents for postoperative residual neuromuscular blockade: a retrospective observational study |
title_short |
Usefulness of intra-operative neuromuscular blockade monitoring and reversal agents for postoperative residual neuromuscular blockade: a retrospective observational study |
title_full |
Usefulness of intra-operative neuromuscular blockade monitoring and reversal agents for postoperative residual neuromuscular blockade: a retrospective observational study |
title_fullStr |
Usefulness of intra-operative neuromuscular blockade monitoring and reversal agents for postoperative residual neuromuscular blockade: a retrospective observational study |
title_full_unstemmed |
Usefulness of intra-operative neuromuscular blockade monitoring and reversal agents for postoperative residual neuromuscular blockade: a retrospective observational study |
title_sort |
usefulness of intra-operative neuromuscular blockade monitoring and reversal agents for postoperative residual neuromuscular blockade: a retrospective observational study |
publisher |
BMC |
series |
BMC Anesthesiology |
issn |
1471-2253 |
publishDate |
2019-08-01 |
description |
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. |
topic |
Neuromuscular blockade Residual neuromuscular blockade Neuromuscular blockade monitoring |
url |
http://link.springer.com/article/10.1186/s12871-019-0817-4 |
work_keys_str_mv |
AT gonzalodomenech usefulnessofintraoperativeneuromuscularblockademonitoringandreversalagentsforpostoperativeresidualneuromuscularblockadearetrospectiveobservationalstudy AT matiasakampel usefulnessofintraoperativeneuromuscularblockademonitoringandreversalagentsforpostoperativeresidualneuromuscularblockadearetrospectiveobservationalstudy AT mariaegarciaguzzo usefulnessofintraoperativeneuromuscularblockademonitoringandreversalagentsforpostoperativeresidualneuromuscularblockadearetrospectiveobservationalstudy AT delfinasancheznovas usefulnessofintraoperativeneuromuscularblockademonitoringandreversalagentsforpostoperativeresidualneuromuscularblockadearetrospectiveobservationalstudy AT sergioaterrasa usefulnessofintraoperativeneuromuscularblockademonitoringandreversalagentsforpostoperativeresidualneuromuscularblockadearetrospectiveobservationalstudy AT gustavogarciafornari usefulnessofintraoperativeneuromuscularblockademonitoringandreversalagentsforpostoperativeresidualneuromuscularblockadearetrospectiveobservationalstudy |
_version_ |
1724473498253918208 |