Postoperative residual neuromuscular block: a survey of management

Background. To avoid postoperative residual neuromuscular blockthere is a need for a change in clinician's attitude towardsmonitoring and reversal. This study aims to evaluate changesof perioperative neuromuscular block management during the lastdecade in our institution and to quantify the incidence of postoperativeresidual neuromuscular block. Methods. Patients receiving intermediate-acting neuromuscularblocking agents for scheduled surgical procedures during 3-monthperiods in 1995 (n=435), 2000 (n=130), 2002 (n=101), and in2004 (n=218) were prospectively and successively enrolled inour study. The management of neuromuscular block in the operatingroom and the adequacy of the recovery were at the discretionof the anaesthesiologist. An attempt was made between each studyperiod to promote a change in the management of neuromuscularblock. In the post-anaesthesia care unit, train-of-four (TOF)stimulations were used to assess the presence of a residualneuromuscular block. Results. Between 1995 and 2004 quantitative measurement andreversal of neuromuscular block in the operating room increasedfrom 2 to 60% and from 6 to 42%, respectively (P<0.001).During the same time, the incidence of residual neuromuscularblock defined as a TOF ratio less than 0.9 decreased from 62to 3% (P<0.001). Use of objective neuromuscular monitoringand/or anticholinesterase drugs was less likely in patientswith an inadequate recovery (P<0.001). Conclusions. During the last decade the incidence of residualneuromuscular block strongly decreased in our institution. Itconfirms the positive impact of neuromuscular monitoring andreversal of neuromuscular block in routine anaesthetic practice.