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Current Anesthesiology Reports
Published in: Current Anesthesiology Reports 2/2016

01-06-2016 | Neuromuscular Blockade (GS Murphy, Section Editor)

Dosing, Monitoring, and Reversal of Neuromuscular Blockade: Are Anesthesiologists Following Evidence-Based Practices?

Authors: Moumen Asbahi, Roy Soto

Published in: Current Anesthesiology Reports | Issue 2/2016

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Abstract

Paralysis is an integral component of many balanced anesthetics, and appropriate dosing, monitoring, and reversal of paralytic agents are important aspects of anesthetic care. Recommendations for all three have been well-described in the literature, yet the literature is also replete with evidence that providers often do not follow published guidelines, and that patients suffer with residual paralysis with subsequent serious or catastrophic sequelae. We discuss appropriate evidence-based techniques for dosing, monitoring, and reversal of paralytic agents, and barriers to implementation of best practices.
Literature
1.
Bevan DR, Donati F, Kopman AF. Reversal of neuromuscular blockade. Anesthesiology. 1992;77:785–805.CrossRef
2.
• Todd MM, Hindman BJ, King BJ. The implementation of quantitative electromyographic neuromuscular monitoring in an academic anesthesia department. Anesth Analg. 2014;119:323–31. Implementation of quantitative neuromuscular blockade monitoring resulted in a significant reduction in the incidence of incompletely reversed patients in the PACU.
3.
• McLean DJ, Diaz-Gil D, Farhan HN, Ladha KS, Kurth T, Eikermann M. Dose-dependent association between intermediate-acting neuromuscular-blocking agents and postoperative respiratory complications. Anesthesiology. 2015;122:1201–13. Study which shows a neuromuscular blocking agent dose dependent association with increased risk of respiratory complications in the postoperative period; and also suggesting that the proper use of neostigmine guided by neuromuscular transmission monitoring results can help eliminate postoperative respiratory complications associated with neuromuscular-blocking agents.
4.
Madsen MV, Staehr-Rye AK, Gatke MR, Claudis C. Neuromuscular blockade for optimising surgical conditions during abdominal and gynaecological surgery: a systemic review. Acta Anaesthesiol Scand. 2015;59:1–16.CrossRef
5.
Fuchs-Buder T, Hofmockel R, Geldner G, Diefenbach C, Ulm K, Blobner M. The use of neuromuscular monitoring in Germany. Anaesthesist. 2003;52:522–6.CrossRef
6.
Thilen SR, Hansen BE, Ramaiah R, Kent CD, Treggiari MM, Bhananker SM. Intraoperative neuromuscular monitoring site and residual paralysis. Anesthesiology. 2012;117:964–72.CrossRef
7.
Grayling M, Sweeney BP. Recovery of neuromuscular blockade: a survey of practice. Anaesthesia. 2007;62:806–9.CrossRef
8.
•• Checketts MR, Alladi R, Ferguson K, et al. Recommendations for standards of monitoring during anaesthesia and recovery 2015: Association of Anaesthesists of Great Britain and Ireland. Anaesthesia 2015. Guidelines for UK and Irish anesthetists for physiological monitoring of patients undergoing both sedation and general anaesthesia. Minimum standards for monitoring patients during and in recovery, with new sections discussing the role of monitoring depth of anaesthesia, neuromuscular blockade, and cardiac output.
9.
Sasaki N, Meyer MJ, Malviya SA, Stanislaus AB, MacDonald T, Doran ME, Igumenshcheva A, Hoang AH, Eikermann M. Effects of neostigmine reversal of nondepolarizing neuromuscular blocking agents on postoperative respiratory outcomes: a prospective study. Anesthesiology. 2014;121:959–68.CrossRef
10.
Fuchs-Buder T, Meitelman C, Alla F, Grandjean A, Wuthrich Y, Donati F. Antagonism of low degrees of atracurium-induced neuromuscular blockade. Dose-effect relationships for neostigmine. Anesthesiology. 2010;112:34–40.CrossRef
11.
Fuchs-Buder T, Baumann C, De Guis J, Guerci P, Meistelman C. Low-dose neostigmine to antagonize shallow atracurium neuromuscular block during inhalational anaesthesia: a randomized controlled trial. Eur J Anaesth. 2013;30:594–8.CrossRef
12.
Naguib M, Kopman AF, Lien CA, Hunter JM, Lopez A, Brull SJ. A survey of current management of neuromuscular block in the United States and Europe. Anesth Analg. 2010;111:110–9.CrossRef
13.
Kopman AF, Eikermann M. Antagonism of non-depolarising neuromuscular block: current practice. Anaesthesia. 2009;64(Suppl 1):22–30.CrossRef
14.
Murphy GS, Szokol JW, Marymont JH, et al. Intraoperative acceleromyographic monitoring reduces the risk of residual neuromuscular blockade and adverse respiratory events in the postanesthesia care unit. Anesthesiology. 2008;109:389–98.CrossRef
15.
Murphy GS, Szokol JW, Marymont JH, et al. Residual neuromuscular blockade and critical respiratory events in the postanesthesia care unit. Anesth Analg. 2008;107:130–7.CrossRef
16.
Debaene B, Plaud B, Dilly M-P, Donati F. Residual paralysis in the PACU after a single intubating dose of nondepolorazing muscle relaxant with an intermediate duration of action. Anesthesiology. 2003;98:1042–8.CrossRef
17.
Arbous MS, Meursing AE, van Kleef JW, de Lange JJ, Spoormans HH, Touw P, Werner FM, Grobbee DE. Impact of anesthesia management characteristics on severe morbidity and mortality. Anesthesiology. 2005;102:257–68.CrossRef
Metadata
Title
Dosing, Monitoring, and Reversal of Neuromuscular Blockade: Are Anesthesiologists Following Evidence-Based Practices?
Authors
Moumen Asbahi
Roy Soto
Publication date
01-06-2016
Publisher
Springer US
Published in
Current Anesthesiology Reports / Issue 2/2016
Electronic ISSN: 2167-6275
DOI
https://doi.org/10.1007/s40140-016-0161-x

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