Objective: Residual neuromuscular blockade (RNMB), defined as a train-of-four ratio (TOFR) <0.90, is a complication of neuromuscular blocking agents (NMBA). Data about RNMB in children are rare. This single-center observational trial evaluated the rate of neuromuscular monitoring (NMM), the incidence, and consequences of RNMB in pediatrics. Methods: Children over 1 month undergoing elective and urgent surgery during core work hours receiving NMBA were included in an 84-day observation period. When the anesthesiologist decided to extubate, a blinded investigator measured the TOFR by acceleromyography. Data on demographics, surgery, anesthesia, and outcome were recorded. Comparison of qualitative variables was done using the chi-square test. The Mann–Whitney U test was used to compare quantitative variables between patients with or without TOFR <0.90. P <0.05 was considered significant. Results: Eighty-nine children were included in the analysis. Rate of quantitative and qualitative NMM was 65.2% and 5.6%, respectively. Incidence of RNMB was 10.1% with TOFRs between 0.78 and 0.89 in 8 children and a TOFR of 0.48 in one child. Median time from the last NMBA administration to the TOFR before extubation was significantly shorter in patients with a TOFR <0.90 in comparison with a TOFR ≥0.90 (88 vs. 110 min). In the RNMB group, qualitative NMM was significantly more often used compared with the no RNMB group (22.2% vs. 3.8%). Adverse events were rare with no significant differences between the two groups. Conclusion: RNMB in children is a relevant hazard. Qualitative NMM is not reliable to exclude RNMB. Institutional training programs on neuromuscular management in children may be helpful to improve the rate of quantitative NMM.
Unterbuchner et al. (Wed,) studied this question.