scholarly journals Improving Neuromuscular Monitoring and Reducing Residual Neuromuscular Blockade With E-Learning: Protocol for the Multicenter Interrupted Time Series INVERT Study

2017 ◽  
Vol 6 (10) ◽  
pp. e192 ◽  
Author(s):  
Jakob Louis Demant Thomsen ◽  
Ole Mathiesen ◽  
Daniel Hägi-Pedersen ◽  
Lene Theil Skovgaard ◽  
Doris Østergaard ◽  
...  
Keyword(s):  
Time Series ◽  
Neuromuscular Blockade ◽  
Interrupted Time Series ◽  
Neuromuscular Monitoring ◽  
Residual Neuromuscular Blockade ◽  
E Learning

scholarly journals The Association Between Residual Neuromuscular Blockade (RNMB) and Critical Respiratory Events: A Prospective Cohort Study

2020 ◽  
Author(s):  
Faraj Alenezi ◽  
Khalid Alnababtah ◽  
Mohammed Alqahtani ◽  
Mohammed Al Harbi
Keyword(s):  
Cohort Study ◽  
General Anaesthesia ◽  
Neuromuscular Blockade ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Neuromuscular Monitoring ◽  
Adult Patients ◽  
Residual Neuromuscular Blockade ◽  
Respiratory Events ◽  
Pacu Stay

Abstract Background: Inadequate neuromuscular recovery might impair pulmonary function among adult patients who undergo general anaesthesia and might thus contribute to critical respiratory events in the post-anaesthesia care unit (PACU). The aim of this study to investigate whether critical respiratory events (CREs) that described in a modified Murphy’s criteria are significantly associated with residual neuromuscular blockade (RNMB).Method: A prospective cohort study from January to March 2017 from a tertiary hospital from Saudi Arabia for thirty adult patients over 18 years old scheduled for elective surgery under general anaesthesia with neuromuscular blocking drugs (NMBDs) were enrolled in the study. The Mann-Whitney U tests, Chi-Square tests and Independent-Samples T tests were used. The Train-of-four (TOF) ratios were measured upon arrival in the PACU by using Acceleromyography with TOF-Scan. Subjects’ demographics, perioperative data, and the occurrence of postoperative CREs in the PACU were recorded.Results: 26 (86.7%) patients out of thirty in the study has received Rocuronium as NMBDs while Neostigmine as a reversal drug with only 23 (76.7%). The incidence of RNMB (TOF ratio < 0.9) was in 16 patients (53.3%). The incidence of RNMB was significantly higher in female patients (p= 0.033), in patients who had not undergone quantitative neuromuscular monitoring before extubation (p= 0.046) and in patients with shorter duration of surgery (p= 0.001). Postoperative CREs occurred in twenty patients (66.7%), and there were significantly more of these CREs among patients with RNMB (P= 0.001). In addition, a statistically significant difference was observed in the occurrence of CREs according to body mass index (P= 0.047).Conclusion: This research showed that RNMB is a significant contributing factor to the development of critical respiratory events during PACU stay. Therefore, optimal antagonism of neuromuscular blockade and routine quantitative neuromuscular monitoring are recommended to reduce the incidence of RNMB.

Neuromuscular Blockers and Reversal Agents

2019 ◽  
Author(s):  
Kristen Flight ◽  
Jennifer J Yang ◽  
Lindsay M Urben ◽  
Michael J Schontz
Keyword(s):  
Neuromuscular Blockade ◽  
Neuromuscular Transmission ◽  
Muscle Relaxation ◽  
Neuromuscular Blocking ◽  
Neuromuscular Monitoring ◽  
Clinical Effects ◽  
Duration Of Action ◽  
Residual Neuromuscular Blockade ◽  
Neuromuscular Blocking Drugs ◽  
Reversal Agents

Neuromuscular blocking drugs, which include depolarizing and nondepolarizing drugs, are used to facilitate intubation and provide skeletal muscle relaxation during surgery and in the intensive care unit. The agents differ in their mechanism, duration of action, side-effect profile, and metabolism. Succinylcholine is the only depolarizing agent in clinic use and is typically used for emergent control of the airway, rapid sequence intubations, and short surgical procedures. The risk of hyperkalemia in certain clinical conditions and risk of malignant hyperthermia in susceptible individuals limit the use of succinylcholine in specific patient populations. Nondepolarizing agents vary in their duration of action, but all provide muscle relaxation for a longer duration than succinylcholine. Clinical effects of neuromuscular blocking drugs can be assessed with neuromuscular monitoring, although there is significant variability among providers in the regular use of neuromuscular monitoring. Reversal agents are used to restore neuromuscular transmission, as residual neuromuscular blockade after extubation has been associated with multiple adverse events, including hypoxemia, atelectasis, and aspiration. Sugammadex is an encapsulating agent capable of immediately reversing the effects of rocuronium-induced neuromuscular blockade that will likely impact the way many providers administer rocuronium and may decrease the future use of succinylcholine. This review contains 4 figures, 6 tables, and 41 references. Keywords: hyperkalemia, neuromuscular monitoring, neuromuscular transmission, nondepolarizing neuromuscular blocking agents, residual neuromuscular blockade, reversal agents, succinylcholine sugammadex, sugammadex

scholarly journals THE ASSOCIATION BETWEEN RESIDUAL NEUROMUSCULAR BLOCKADE (RNMB) AND CRITICAL RESPIRATORY EVENTS: A PROSPECTIVE COHORT STUDY

2020 ◽  
Author(s):  
Faraj Alenezi ◽  
Khalid Alnababtah ◽  
Mohammed Alqahtani ◽  
Mohammed Al Harbi ◽  
Lafi Olayan
Keyword(s):  
Cohort Study ◽  
General Anaesthesia ◽  
Neuromuscular Blockade ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Neuromuscular Monitoring ◽  
Adult Patients ◽  
Residual Neuromuscular Blockade ◽  
Respiratory Events ◽  
Pacu Stay

Abstract Background: Inadequate neuromuscular recovery might impair pulmonary function among adult patients who undergo general anaesthesia and might thus contribute to critical respiratory events in the post-anaesthesia care unit (PACU). The aim of this study to investigate whether critical respiratory events (CREs) that described in a modified Murphy’s criteria are significantly associated with residual neuromuscular blockade (RNMB).Method: A prospective cohort study from January to March 2017 from a tertiary hospital from Saudi Arabia for thirty adult patients over 18 years old scheduled for elective surgery under general anaesthesia with neuromuscular blocking drugs (NMBDs) were enrolled in the study. The Mann-Whitney U tests, Chi-Square tests and Independent-Samples T tests were used. The Train-of-four (TOF) ratios were measured upon arrival in the PACU by using Acceleromyography with TOF-Scan. Subjects’ demographics, perioperative data, and the occurrence of postoperative CREs in the PACU were recorded. Results: 26 (86.7%) patients out of thirty in the study has received Rocuronium as NMBDs while Neostigmine as a reversal drug with only 23 (76.7%). The incidence of RNMB (TOF ratio < 0.9) was in 16 patients (53.3%). The incidence of RNMB was significantly higher in female patients (p= 0.033), in patients who had not undergone quantitative neuromuscular monitoring before extubation (p= 0.046) and in patients with shorter duration of surgery (p= 0.001). Postoperative CREs occurred in twenty patients (66.7%), and there were significantly more of these CREs among patients with RNMB (P= 0.001). In addition, a statistically significant difference was observed in the occurrence of CREs according to body mass index (P= 0.047). Conclusion: This research showed that RNMB is a significant contributing factor to the development of critical respiratory events during PACU stay. Therefore, routine quantitative neuromuscular monitoring is recommended to reduce the incidence of RNMB.

Predictive Study of Pharmacological Reversal for Residual Neuromuscular Blockade, Early and Late Postoperative Pulmonary Complications: A Prospective, Observational, Cohort Study

2021 ◽  
Author(s):  
Cristian Aragón-Benedí ◽  
Ana Pascual-Bellosta ◽  
Sonia Ortega-Lucea ◽  
Sara Visiedo-Sanchez ◽  
Javier Martinez-Ubieto
Keyword(s):  
Cohort Study ◽  
Neuromuscular Blockade ◽  
Demographic Data ◽  
Pulmonary Complications ◽  
Neuromuscular Monitoring ◽  
Observational Cohort Study ◽  
Prospective Observational Cohort Study ◽  
Postoperative Pulmonary Complications ◽  
Residual Neuromuscular Blockade ◽  
Observational Cohort

Abstract Background The primary objective was to assess the incidence of residual neuromuscular blockade and postoperative pulmonary complications according to spontaneous or pharmacological neuromuscular reversal, comparing neostigmine and sugammadex. The secondary objective was to present a prognostic model to predict the probability of having residual neuromuscular blockade depending on patient's comorbidities and intraoperative neuromuscular blocking agents management. Methods Single-center, prospective, observational, cohort study including patients undergoing surgical procedures with general anaesthesia divided into four groups: cisatracurium, cisatracurium with neostigmine antagonism, rocuronium, and rocuronium with sugammadex antagonism. A binomial generalized linear model was used to predict the residual neuromuscular blockade analyzing patients demographic data, comorbidities, intraoperative neuromuscular monitoring and pharmacological reversal for each patient group. Results A total of 714 patients were analyzed. According to our model, none of the studied comorbidities were a predisposing factor for an increase in residual neuromuscular blockade. However, the use of rocuronium, pharmacological reversal with sugammadex, and, particularly, neuromuscular monitoring during surgery markedly decreased the probability. When using rocuronium, avoidance of neuromuscular monitoring and pharmacological reversal led to an incidence of residual neuromuscular blockade of 41.27%; conversely, the use of neuromuscular monitoring and pharmacological reversal with sugammadex decreased the probability to 2.17%. Conclusions In our study, intraoperative neuromuscular monitoring and pharmacological reversal with sugammadex, unlike neostigmine, were the factors that most effectively reduced the risk of residual neuromuscular blockade as well as early postoperative pulmonary complications in PACU (upper airway obstruction and desaturation) and late postoperative pulmonary complications (pneumonia or atelectasis) within 30 days.

scholarly journals The latest trend in neuromuscular monitoring: return of the electromyography

2021 ◽  
Author(s):  
Wonjin Lee
Keyword(s):  
Neuromuscular Blockade ◽  
Monitoring System ◽  
Gold Standard ◽  
Neuromuscular Monitoring ◽  
Residual Neuromuscular Blockade ◽  
Train Of Four

To reduce the risk of residual neuromuscular blockade, neuromuscular monitoring must be performed. Acceleromyography (AMG)-based neuromuscular monitoring was regarded as “clinical gold standard” and widely applied. However, issues related to patient’s posture and overestimation of train-of-four ratio associated with AMG-based neuromuscular monitoring have increased. Recently, electromyography (EMG)-based neuromuscular monitoring is receiving renewed attention, since it overcomes AMG’s weaknesses. However, both AMG-based and EMG-based systems are useful when certain considerations are followed. Ultimately, to assure the patient’s good outcomes, the choice of monitoring system is not as important as the monitoring itself, which should be always implemented in such patients.

scholarly journals The association between residual neuromuscular blockade (RNMB) and critical respiratory events: a prospective cohort study

2021 ◽  
Vol 10 (1) ◽  
Author(s):  
Faraj K Alenezi ◽  
Khalid Alnababtah ◽  
Mohammed M Alqahtani ◽  
Lafi Olayan ◽  
Mohammed Alharbi
Keyword(s):  
Cohort Study ◽  
General Anaesthesia ◽  
Neuromuscular Blockade ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Neuromuscular Monitoring ◽  
Adult Patients ◽  
Residual Neuromuscular Blockade ◽  
Respiratory Events ◽  
Pacu Stay

Abstract Background Inadequate neuromuscular recovery might impair pulmonary function among adult patients who undergo general anaesthesia and might thus contribute to critical respiratory events in the post-anaesthesia care unit (PACU). The pilot study aims to understand the baseline incidence of residual neuromuscular blockade (RNMB) and postoperative critical respiratory events (CREs), which are described in a modified Murphy’s criteria in the PACU. Method This is a prospective cohort study from January to March 2017 from a tertiary hospital in Saudi Arabia with thirty adult patients over 18 years old scheduled for elective surgery under general anaesthesia with neuromuscular blocking drugs (NMBDs) who were enrolled in the study. The Mann-Whitney U tests, chi-square tests and independent-samples T tests were used. The train-of-four (TOF) ratios were measured upon arrival in the PACU by using acceleromyography with TOF-Scan. Subjects’ demographics, perioperative data and the occurrence of postoperative CREs in the PACU were recorded. Results Twenty-six (86.7%) patients out of thirty in the study have received rocuronium as NMBDs whilst neostigmine as a reversal drug with only 23 (76.7%). The incidence of RNMB (TOF ratio < 0.9) was in 16 patients (53.3%). The incidence of RNMB was significantly higher in female patients (p = 0.033), in patients who had not undergone quantitative neuromuscular monitoring before extubation (p = 0.046) and in patients with a shorter duration of surgery (p = 0.001). Postoperative CREs occurred in twenty patients (66.7%), and there were significantly more of these CREs among patients with RNMB (p = 0.001). In addition, a statistically significant difference was observed in the occurrence of CREs according to body mass index (p = 0.047). Conclusion This research showed that RNMB is a significant contributing factor to the development of critical respiratory events during PACU stay. Therefore, routine quantitative neuromuscular monitoring is recommended to reduce the incidence of RNMB.

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