Should Neuromuscular Blockade Be Routinely Reversed?
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Purpose of review
The purpose of this article is to present the consequences and incidence of residual paralysis and define solutions to reduce the risk of its occurrence.
Small degrees of residual paralysis, defined as a train-of-four (TOF) ratio < 0.9, may increase the risk of postoperative respiratory complications and influence outcomes following surgery. Routine monitoring of neuromuscular block can allow the detection of incomplete neuromuscular recovery and is an important factor in the prevention of residual paralysis. Administration of neostigmine or sugammadex to reverse residual paralysis should be based on the degree of spontaneous recovery. Sugammadex acts much faster than neostigmine and can even reverse deep levels of neuromuscular blockade.
Meticulous management of neuromuscular blockade, including routine reversal of the effects of muscle relaxants, is essential in avoiding residual block and associated complications.
KeywordsResidual paralysis Neuromuscular blocking agents Neuromuscular monitoring Postoperative respiratory complications Anticholinesterase agents Neostigmine Sugammadex
Compliance with Ethical Standards
Conflict of Interest
Julien Raft declares that he has no conflict of interest.
Claude Meistelman has received financial support through a grant as well as compensation from MSD for service as a consultant.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Paper of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
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