[Residual neuromuscular blockade during recovery from anesthesia in respiratory endoscopy: a report of three cases and literature review].

Objective: To investigate the clinical risks and preventive strategies of residual neuromuscular blockade during the recovery period after general anesthesia for respiratory endoscopy. Methods: A retrospective analysis of 3 cases of respiratory endoscopy under intravenous general anesthesia was conducted at Chuiyangliu Hospital Affiliated to Tsinghua University in 2024. Relevant literature was searched in the Pubmed and Wanfang database to summarize and analyze the clinical manifestations and risks. Results: The 3 patients at our hospital underwent thorough evaluation before operation. Sedation and analgesia were administered, along with 0.1-0.2 mg/kg dose of the neuromuscular blocking agent succinylcholine. The bronchoscopy procedure was successful. Neostigmine was administered for antagonism after bronchoscopy in all 3 cases, but adverse events occurred during anesthesia recovery. The first patient experienced persistent chest tightness, despite normal results from auxiliary examination, and psychological testing suggested an anxiety state, which improved after psychological intervention. The second patient developed respiratory and heart failure but was successfully resuscitated. The third patient experienced prolonged hypoxemia during the recovery period from anesthesia. Literature analysis showed that residual neuromuscular block during the recovery period can manifest clinically as chest tightness, respiratory muscle weakness, hypoxemia, respiratory failure and heart failure. Residual neuromuscular block is common and causes severe adverse clinical effects. However, despite its serious clinical impact, residual neuromuscular block has not attracted much clinical attention. Conclusion: The clinical hazards associated with residual neuromuscular blockade are not widely recognized, and effective preventive strategies must be developed to mitigate these risks.