Postoperative residual block after intermediate-acting neuromuscular blocking drugs |
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Authors: | Hayes A H Mirakhur R K Breslin D S Reid J E McCourt K C |
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Institution: | Department of Anaesthetics and Intensive Care Medicine, The Queen's University of Belfast, Whitla Medical Building, 97 Lisburn Road, Belfast BT9 7BL, UK. |
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Abstract: | The frequency and duration of postoperative residual neuromuscular block on arrival of 150 patients in the recovery ward following the use of vecuronium (n = 50), atracurium (n = 50) and rocuronium (n = 50) were recorded. Residual block was defined as a train-of-four ratio of <0.8. An additional group of 10 patients received no neuromuscular blocking drugs during anaesthesia. The incidence of postoperative residual neuromuscular block was 64%, 52% and 39% after the use of vecuronium, atracurium and rocuronium, respectively. Similar numbers of patients were not able to maintain a sustained head or leg lift for 5 s on arrival in the recovery ward. The mean range] times to attaining a train-of-four ratio of > or =0.8 after arrival in the recovery ward were 9.2 1-61], 6.9 1-24] and 14.7 1.5-83] min for vecuronium, atracurium and rocuronium, respectively. None of the 10 patients who did not receive neuromuscular blocking drugs had train-of-four ratios <0.8 on arrival in the recovery ward. It is concluded that a large proportion of patients arrive in the recovery ward with a train-of-four ratio <0.8, even with the use of intermediate-acting neuromuscular blocking drugs. Although the residual block is relatively short lasting, it may occasionally be prolonged, requiring close observation and monitoring of such patients in the recovery ward. |
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Keywords: | Neuromuscular blocking drugs atracurium rocuronium vecuronium Antagonists neuromuscular relaxants Monitoring neuromuscular function |
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