Should Neuromuscular Blockade Be Routinely Reversed?

Neuromuscular Blockade (GS Murphy, Section Editor)
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Part of the following topical collections:
  1. Neuromuscular Blockade

Abstract

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.

Recent findings

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.

Summary

Meticulous management of neuromuscular blockade, including routine reversal of the effects of muscle relaxants, is essential in avoiding residual block and associated complications.

Keywords

Residual paralysis Neuromuscular blocking agents Neuromuscular monitoring Postoperative respiratory complications Anticholinesterase agents Neostigmine Sugammadex 

Notes

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.

References

Paper of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Anesthesiology, Hopital Maisonneuve-RosemontUniversité de MontréalMontréalCanada
  2. 2.Department of Anesthesiology and Intensive Care Medicine, Hopital de BraboisUniversité de LorraineVandoeuvreFrance

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