Respiratory function in children during recovery from neuromuscular blockade

Residual neuromuscular blockade is a major risk factor for respiratory insufficiency. We examined the relationship between neuromuscular and respiratory function in 18 ASA I or II children aged 2–4 years. Lung function was measured by pneumotachography and transpulmonary pressure, neuromuscular transmission by first twitch response ratio (T1:T1) and train-of-four ratio (TOFR), before and at specific points in recovery from vecuronium paralysis. The tidal volume was directly related to maximal inspiratory pressure at occlusion ( P _Iocc), P <0.001, whereas the minute ventilation (V_E) was related to the respiratory drive (P0.1), P <0.001. The best predictors of minute ventilation were the P0.1 ( r =0.57), and the TOFR ( r =0.62). P _Iocc and P0.1 correlated closely ( r =0.889, P =0.002) but TOFR and T1:T1 did not correlate with either. Our results show that the occlusion pressure measurements, P0.1 and P _Iocc, were good predictors of both V_E·kg⁻¹ and respiratory work.