Residual neuromuscular blockade in a real life clinical setting: correlation with sugammadex or neostigmine administration

BACKGROUND

The aim of this study was to identify the frequency of residual neuromuscular blockade (RNMB) in the postanesthesia care unit (PACU) of a tertiary university hospital in Greece, and its correlation with reversal agents. The influence of other perioperative factors was assessed secondarily.

METHODS

Patients >18 years old, undergoing surgery with general anesthesia were prospectively studied during a 6-month period. Immediately after arrival at the PACU, the train-of-four ratio (TOF) was assessed by independent investigators, using accelerometry 3 consecutive times, and the mean value was calculated. When TOF was <0.9, RNMB was diagnosed and further interventions were decided. All perioperative data, including history of patients, anesthetic drugs used and surgical details, were recorded from the patients' files.

RESULTS

Five hundred twenty patients were studied; 90.4% received rocuronium, 9.2% cis-atracurium, and 0.4% succinylcholine. The prevalence of RNMB was 10.8%. A significant difference (P=0.0006) was detected between patients who received neostigmine versus sugammadex, with the latter showing higher TOF values postoperatively, although the actual incidence of RNMB did not differ between the two groups. Patients with coexisting diseases received sugammadex more frequently (P<0.001), while women, and patients ASA>III were more likely to exhibit RNMB (P=0.02 and P=0.05 respectively).

CONCLUSIONS

The frequency of RNMB was 10.8%. Patients who received sugammadex presented with higher TOF values at the PACU, although no difference in RNMB was detected compared to neostigmine. Female gender and the presence of comorbidities increased the possibility to exhibit RNMB at the PACU.