Residual Neuromuscular Blockade: A Persistent Clinical Problem

The muscle relaxants have been singled out from the other agents and technics for particular discussion because of their newness, because of their greatly increasing use, and because their employment appears to be associated with certain anesthetic hazards not yet entirely clear, nor completely appreciated. 1 In the classic study of deaths associated with anesthesia and surgery, Beecher and Todd 1 in 1954 reported a 6-fold increase in the death rate of patients undergoing general anesthesia when ‘‘curare’ ’ was used compared with anesthesia without neuromuscular blockade (NMB). Their study must be viewed in the context of the initial use of neuromuscular blocking drugs (NMBDs) (curare) with volatile anesthetics such as cyclopropane, ether, and trichloroethylene, and the absence of capnography, pulse oximetry, and electrocardiography, which are now the standard of care. The first routine method for monitoring the depth and recovery of NMB 2–4 was still 2 decades away. Today’s marketed NMBDs are noted for their hemodynamic stabilities,