Key result
Residual neuromuscular blockade upon arrival in the post-anesthesia care unit was associated with a significantly higher rate of postoperative respiratory complications compared to patients without residual blockade (46.7% vs 9.6%, p<0.001).
Why the study?
Residual neuromuscular blockade from neuromuscular blocking agents can lead to respiratory complications in post-anesthesia care units, but its incidence and relationship with postoperative airway and respiratory issues required investigation.
Does residual neuromuscular blockade upon PACU arrival increase the risk of postoperative respiratory complications in patients undergoing general anesthesia?
Observational (n=82)
Single-blind
No
Does residual neuromuscular blockade upon PACU arrival increase the risk of postoperative respiratory complications in patients undergoing general anesthesia?
Residual neuromuscular blockade upon PACU arrival is common and significantly increases the risk of postoperative respiratory complications, highlighting the need for routine quantitative neuromuscular monitoring.
RNMB upon PACU arrival was associated with higher respiratory complications; leaves open whether routine quantitative monitoring improves outcomes.
Background Neuromuscular blocking agents (NMBAs) are employed during general anesthesia induction for endotracheal intubation and to facilitate specific surgeries requiring muscle relaxation. However, residual neuromuscular blockade (RNMB) can lead to respiratory complications in post-anesthesia care units (PACUs). This study investigates RNMB incidence in PACUs and its association with postoperative airway and respiratory issues. Methods A prospective observational study on patients undergoing general anesthesia with NMBAs was conducted at the Department of Anesthesia, Salmaniya Medical Complex, Bahrain, over six months (April to September 2023). Train-of-four (TOF) ratios were calculated using an acceleromyograph upon PACU arrival. Data on demographics, perioperative variables, and postoperative complications were recorded. Results Among 82 patients, 30 (36.6%) had RNMB upon PACU arrival. RNMB incidence declined: 17.1% at 10 minutes, 6.1% at 20 minutes, and 2.4% at 30 minutes, resolving by 40 minutes. Demographics and procedure duration showed no correlation with RNMB. Postoperative respiratory complications affected 23.2% of patients, notably higher in those with RNMB (p = 0.001). Among patients with TOF <90% at PACU arrival, 46.7% experienced complications compared to 9.6% with TOF ≥90% (p<0.001). Participants without RNMB had a significantly higher weight (p = 0.046). Airway support was required for 30% of patients, all with TOF <90% (p<0.001). Conclusion This study emphasizes the importance of assessing and monitoring neuromuscular function to detect and prevent RNMB in PACUs. RNMB presence correlated with an increased susceptibility to postoperative respiratory complications. Regular quantitative neuromuscular monitoring is advisable in clinical practice to proactively mitigate RNMB incidence and its complications.
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Bucheery et al. (2023) conducted an observational in Patients undergoing general anesthesia with neuromuscular blocking agents (n=82). Residual neuromuscular blockade (TOF ratio < 0.9) vs. No residual neuromuscular blockade (TOF ratio ≥ 0.9) was evaluated on Postoperative respiratory complications (p=<0.001). Residual neuromuscular blockade upon arrival in the post-anesthesia care unit was associated with a significantly higher rate of postoperative respiratory complications compared to patients without residual blockade (46.7% vs 9.6%, p<0.001).
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