scholarly journals Introduction of sugammadex as standard reversal agent: Impact on the incidence of residual neuromuscular blockade and postoperative patient outcome

2013 ◽  
Vol 57 (1) ◽  
pp. 46 ◽  
Author(s):  
Thomas Ledowski ◽  
Samuel Hillyard ◽  
Brendan O′Dea ◽  
Rob Archer ◽  
Filipe Vilas-Boas ◽  
...  
Keyword(s):  
Patient Outcome ◽  
Neuromuscular Blockade ◽  
Reversal Agent ◽  
Postoperative Patient ◽  
Residual Neuromuscular Blockade

scholarly journals Repeat Administration of Reversal Agents in Patients Receiving Neostigmine or Sugammadex: A Retrospective Observational Study

2020 ◽  
Author(s):  
Laura Gilbertson ◽  
Francis Wolf ◽  
Grant C. Lynde
Keyword(s):  
Neuromuscular Blockade ◽  
Repeated Administration ◽  
Not Given ◽  
Reversal Agent ◽  
Progressive Decline ◽  
Residual Neuromuscular Blockade ◽  
Reversal Agents ◽  
Rescue Dose ◽  
Repeat Administration ◽  
Effective Use

Abstract Background: Antagonism of neuromuscular blockade (NMB) induced by rocuronium and vecuronium can be achieved with either neostigmine or sugammadex. Compared to sugammadex, antagonism with neostigmine is more likely to result in incomplete reversal, i.e. residual neuromuscular blockade (rNMB). The administration of additional doses of a reversal agent following an initial reversal dose may be a marker for suspected rNMB. We studied the frequency and temporal patterns of repeat (rescue) administration of reversal agents in patients who received an initial dose of neostigmine vs. sugammadex. Methods: We analyzed retrospective data from electronic anesthesia records to identify surgical patients who received rescue dose reversal, defined as two or more doses of reversal agent, following administration of non-depolarizing NMB and extubation in the operating room. We assessed rates of rescue reversal over time following the introduction of sugammadex and compared rescue rates for patients receiving neostigmine vs sugammadex. Results: A total of 24,027 cases using cisatracurium, rocuronium, and vecuronium were analyzed. Following the addition of sugammadex to formulary in 2016, reversal with neostigmine decreased from 79% to 5.3% (p <0.001) and the use of rescue reversal after neostigmine increased from 6.0% to 18% (p<0.001). In contrast, rescue reversal after sugammadex was 2.5%, with no change over the study period (p=0.059). The percentage of patients who were not given any reversal agent following non-depolarizing NMB decreased from 20% to 13% (p<0.001). As neostigmine usage progressively decreased after introduction of sugammadex, there was a corresponding increase in rescue reversal dosing when initial reversal was attempted with neostigmine. Conclusions: Repeated administration of a reversal agent was 7 times more likely to occur in patients initially reversed with neostigmine compared to sugammadex. This finding likely reflects increased rates of observed weakness in patients reversed with neostigmine. The correlation between decreasing neostigmine use and increasing rescue reversal after neostigmine may indicate a progressive decline in the effective use of neostigmine (as knowledge and experience waned), and/or decreasing confidence in its efficacy.

Post-operative residual neuromuscular blockade after the administration of a single intubating dose of intermediate-acting non-depolarising neuromuscular blocking agent in adult elective surgical procedures

2020 ◽  
Vol 64 ◽  
pp. 142-146
Author(s):  
Rita Mae J. Gollaba ◽  
Derick Erl P. Sumalapao ◽  
Mary Ellen M. Chiong-Perez
Keyword(s):  
Neuromuscular Blockade ◽  
Surgical Procedures ◽  
Short Interval ◽  
Blocking Agent ◽  
Neuromuscular Blocking ◽  
Neuromuscular Blocking Agent ◽  
Reversal Agent ◽  
Post Anaesthesia Care Unit ◽  
Residual Neuromuscular Blockade ◽  
Anaesthesia Care

Objectives: Post-operative residual neuromuscular blockade may result in life-threatening conditions if not properly managed making it a common and significant concern among anaesthesiologists. Among adult elective surgeries requiring single intubating dose of intermediate-acting non-depolarising neuromuscular blocking agent, the study determined the incidence and risk factors associated with post-operative residual neuromuscular blockade during early post-operative period. Materials and Methods: A prospective, open-labelled, non-randomised observational study conducted in an operating room and post-anaesthesia care unit. A total of 175 ASA-PS Class I and II patients admitted in the surgical wards scheduled for elective surgical operation and were administered of a single intubating dose of intravenous intermediate-acting non-depolarising neuromuscular blocking drug. The train-of-four (TOF) method of peripheral nerve stimulation detects the presence of post-operative residual neuromuscular blockade. Results: A significant post-operative residual paralysis was identified in specific age groups (26–35, 46–55 and 56–65), in surgical procedures in the orthopaedic service, and among patients who were given a reversal agent. Residual neuromuscular blockade is still present even if the interval between the last dose of muscle relaxant and the measurement of TOF ratio at the post-anaesthesia care unit was long, however, less than that observed in short interval surgeries. Conclusion: Clinical importance of residual neuromuscular blockade is still evident up to the present time and the present study recommends routine monitoring of neuromuscular blockade and pharmacologic antagonism in the reversal of non-depolarising neuromuscular blocking drugs.

scholarly journals The Effect of Preload on Electromyographic Train-Of-Four Ratio at the First Dorsal Interosseous Muscle during Spontaneous Recovery from Neuromuscular Blockade

2018 ◽  
Vol 46 (6) ◽  
pp. 614-619
Author(s):  
A. Bansal ◽  
P. A. Stewart ◽  
S. Phillips ◽  
S. Liang ◽  
X. Wang
Keyword(s):  
Neuromuscular Blockade ◽  
Spontaneous Recovery ◽  
Repeated Measurements ◽  
First Dorsal Interosseous ◽  
Reversal Agent ◽  
Residual Neuromuscular Blockade ◽  
Train Of Four ◽  
First Dorsal Interosseous Muscle ◽  
Induction Of Anaesthesia ◽  
Dorsal Interosseous Muscle

Accurate and reliable quantitative neuromuscular function monitoring is desirable for the optimal management of neuromuscular blockade, selection of the most appropriate reversal agent and dosage, and assessing the completeness of reversal to exclude residual neuromuscular blockade. Applying preload to the thumb may affect the precision of electromyography. This study compared the precision and agreement of electromyography with and without preload during recovery from non-depolarising neuromuscular blockade. After induction of anaesthesia and before neuromuscular blockade, the supramaximal current required at the first dorsal interosseous muscle with and without preload was determined. During recovery, train-of-four ratios were recorded using electromyography every 20 seconds. Alternating pairs of measurements (with and without preload) were obtained until spontaneous recovery was achieved. The preload device applied a resting tension of 75–150 g to the thumb. Bland–Altman analysis for repeated measurements was used to assess precision and agreement of electromyography responses with and without muscle preload. Two hundred and seventy-five sets of repeated measurements were collected from 35 participants. The repeatability coefficient for train-of-four ratios recorded by electromyography with a preload was 0.030 (95% confidence intervals, CI, 0.028 to 0.031) versus 0.068 (95% CI 0.064 to 0.072) without. Train-of-four ratios with preload demonstrated a bias of +0.038 (95% CI 0.037 to 0.042) compared to electromyography without, with 95% limits of agreement of 0.035–0.111. Preload significantly improved the precision of electromyographic train-of-four ratios, with 95% of consecutive measurements differing by less than 3%. Furthermore, electromyography with preload demonstrated a positive bias of 0.04 compared with electromyography alone, the clinical significance of which requires further research.

scholarly journals Impaired Upper Airway Integrity by Residual Meeting Abstracts

2009 ◽  
Vol 110 (6) ◽  
pp. 1253-1260 ◽  
Author(s):  
Frank Herbstreit ◽  
Jürgen Peters ◽  
Matthias Eikermann
Keyword(s):  
Neuromuscular Blockade ◽  
Lung Volume ◽  
Upper Airway ◽  
Random Order ◽  
Compensatory Response ◽  
Residual Neuromuscular Blockade ◽  
Pharyngeal Pressure ◽  
Pressure Threshold ◽  
Airway Collapsibility ◽  
Closing Pressure

Background Residual neuromuscular blockade increases the risk to develop postoperative complications. The authors hypothesized that minimal neuromuscular blockade (train-of-four [TOF] ratio 0.5-1) increases upper airway collapsibility and impairs upper airway dilator muscle compensatory responses to negative pharyngeal pressure challenges. Methods Epiglottic and nasal mask pressures, genioglossus electromyogram, respiratory timing, and changes in lung volume were measured in awake healthy volunteers (n = 15) before, during (TOF = 0.5 and 0.8 [steady state]), and after recovery of TOF to unity from rocuronium-induced partial neuromuscular blockade. Passive upper airway closing pressure (negative pressure drops, random order, range +2 to -30 cm H2O) and pressure threshold for flow limitation were determined. Results Upper airway closing pressure increased (was less negative) significantly from baseline by 54 +/- 4.4% (means +/- SEM), 37 +/- 4.2%, and 16 +/- 4.1% at TOF ratios of 0.5, 0.8, and 1.0, respectively (P &lt; 0.01 vs. baseline for any level). Phasic genioglossus activity almost quadrupled in response to negative (-20 cm H2O) pharyngeal pressure at baseline, and this increase was significantly impaired by 57 +/- 44% and 32 +/- 6% at TOF ratios of 0.5 and 0.8, respectively (P &lt; 0.01 vs. baseline). End-expiratory lung volume, respiratory rate, and tidal volume did not change. Conclusion Minimal neuromuscular blockade markedly increases upper airway closing pressure, partly by impairing the genioglossus muscle compensatory response. Increased airway collapsibility despite unaffected values for resting ventilation may predispose patients to postoperative respiratory complications, particularly during airway challenges.

THE RATE OF RESIDUAL NEUROMUSCULAR BLOCKADE AFTER LAPAROSCOPIC APPENDECTOMY SURGERY AT NGUYEN TRI PHUONG HOSPITAL

2021 ◽  
Vol 62 (6) ◽  
Author(s):  
Doan Minh Nhut ◽  
Nguyen Van Chinh
Keyword(s):  
Neuromuscular Blockade ◽  
Laparoscopic Appendectomy ◽  
Muscle Relaxant ◽  
Muscle Relaxation ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Residual Rate ◽  
Residual Neuromuscular Blockade ◽  
Study Results

Introduction: In Vietnam, using a muscle accelerator to measure the TOF index to monitor residue neuromuscular blockade has not been performed routinely, extubation is mainly based on subjective clinical assessments. Methods: A cross-sectional study on 96 patients undergoing laparoscopic appendectomy at Nguyen Tri Phuong Hospital, from November 2020 to May 2021. Objectives: The study was conducted with 2 objectives including (1) Determine the progression of TOF index at 7 time points: immediately after arriving in the recovery room, after extubation, 15 minutes, 30 minutes, 60 minutes, 90 minutes, 120 minutes after extubation; (2) Determination of residual muscle relaxant rate of patients undergoing laparoscopic appendectomy at Nguyen Tri Phuong Hospital. Results: The average TOF ≥ 0,9 index after laparoscopic appendectomy at the time of resuscitation was 88.11%, extubation was 90.53% and at 120 minutes after extubation. is 99.88%. Residual muscle relaxation after surgery when TOF index < 0.9. At the time of resuscitation, the highest residual rate of muscle relaxant accounted for 58.33%, followed by the time of extubation 39.58%, 15 minutes after extubation was 21.88%. Until 120 after extubation, there is no case that has residue neuromuscular blockade. Conclusion: Through the study results, it is necessary to monitor patients undergoing laparoscopic appendectomy with quantitative devices to more accurately assess the clinical index of muscle relaxation.

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