Post-Operative Residual Curarization (PORC): A Big Issue for Patients' Safety

Neuromuscular blocking agents (NMBAs) are still required for the pediatric population. Residual neuromuscular block is a common complication in the early postoperative period. The objective of this study is to compare the efϑicacy of sugammadex versus neostigmine for reversing NMB in pediatric patients with cancer who undergo outpatient surgical procedures. This double-blinded study included 80 children with different oncological diagnoses, aged 2-18 years, scheduled for outpatient surgical procedures. They were randomly divided into two equal groups; Group N received neostigmine 0.03 mg/kg with atropine 0.02 mg/kg and Group S received sugammadex 2 mg/kg at the end of surgery. The patients were clinically assessed for NMB recovery and extubated. The primary outcome measure was the time from NMB reversal to recovery of the TOF ratio to 0.9% (recovery time). The secondary outcomes included the time between reversal injection and extubation (extubation time) and possible adverse events. The time to recovery of the TOF ratio to 0.9 and the time between reversal injection and extubation were signiϑicantly shorter in S Group (p< 0.001). The time to reach TOF ratio of 0.9 was not correlated with age, anesthesia time, or the dose of the neuromuscular blocker. None of the children developed respiratory depression or postoperative residual curarization. Relatively few patients developed arrhythmia, hypotension, and nausea and vomiting with no signiϑicant difference between the two groups. Sugammadex is a good alternative to neostigmine for reversal of neuromuscular block in outpatient surgical procedures in children with cancer; it safely provides faster NMB reversal and extubation time.

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Neuromuscular block monitoring by smartphone application (i-TOF© system): an observational pilot study

npj Digital Medicine ◽

10.1038/s41746-020-00344-w ◽

2020 ◽

Vol 3 (1) ◽

Author(s):

Lorenzo Schiavoni ◽

Giuseppe Pascarella ◽

Stefania Grande ◽

Felice Eugenio Agrò

Keyword(s):

Pilot Study ◽

General Anesthesia ◽

Neuromuscular Block ◽

Good Clinical Practice ◽

Smartphone Application ◽

Comparable Efficacy ◽

Time Intervals ◽

Mean Values ◽

Residual Curarization ◽

Deep Neuromuscular Block

Abstract Neuromuscular block monitoring is recommended by international guidelines to improve myorelaxation during surgery and reduce the risk of postoperative residual curarization. We conducted a pilot study to verify the efficacy of i-TOF, a wireless neuromuscular monitoring device connectable to a smartphone, comparing it with TOF WATCH SX. We enrolled 53 patients who underwent general anesthesia. For each patient, we recorded by both devices, in different time intervals, train-of-four (TOF) count/ratio after induction to general anesthesia (TI0–TI3) and during recovery (TR0–TR3). Moreover, post-tetanic count (PTC) was evaluated during deep neuromuscular block (TP0–TP2). We noticed no significant differences between the devices in recorded mean values of TOF ratio, TOF count, and PTC analyzed at time intervals for every phase of general anesthesia, although the i-TOF tends to an underestimation compared to TOF WATCH SX. For each patient, data sessions were successfully recorded by a smartphone. This aspect could be relevant for clinicians in order to have a stored proof of good clinical practice to be added on anesthesiologist records. By our results, i-TOF demonstrates a comparable efficacy to TOF WATCH SX, suggesting that it could be a proven alternative to standard devices for neuromuscular block monitoring. Further studies are needed to confirm our findings.

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