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Management of Neuromuscular Block in Pediatric Patients — Safety Implications

  • Patient Safety in Anesthesia (SJ Brull and JR Renew, Section Editors)
  • Published:
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Abstract

Purpose of Review

We summarize the current status of neuromuscular blockade monitoring and reversal strategies in children, and the gaps that exist in our knowledge and approach compared to adult practice.

Recent Findings

Children experience residual neuromuscular blockade and are at risk of subsequent complications, though this is less well studied compared to adults. Objective (quantitative) monitoring of neuromuscular blockade in children has been challenging due to patient size and surgical positioning. Recent dosing indications for sugammadex in children and advances in objective monitoring may provide measures to improve patient safety in daily pediatric anesthesia practice.

Summary

As evidence-based practice guidelines are formed, investigations supporting the safe use, monitoring, and reversal of neuromuscular blockade in children are needed. Objective monitoring for appropriate management and reversal of neuromuscular blockade in children should be encouraged, even when using sugammadex.

Search Strategy

A PubMed search was completed using key terms “pediatric anesthesia,” “residual neuromuscular blockade,” “neuromuscular monitoring,” “quantitative monitoring,” and “sugammadex.” The search was conducted in July 2022 and was restricted to English literature. The search included meta-analyses, randomized controlled trials, clinical trials, observational studies, case reports, and reviews within the past 20 years.

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  1. Department of Anesthesiology, Children’s Hospital Colorado, University of Colorado School of Medicine, 13123 East 16th Avenue, B090, Aurora, CO, 80045, USA

    Young May Cha & Debra J. Faulk

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Cha, Y.M., Faulk, D.J. Management of Neuromuscular Block in Pediatric Patients — Safety Implications. Curr Anesthesiol Rep 12, 439–450 (2022). https://doi.org/10.1007/s40140-022-00537-x

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