Residual neuromuscular blockade in the postanesthesia care unit: observational cross-sectional study of a multicenter cohort
Carlos L Errando, Ignacio Garutti, Guido Mazzinari, Óscar Díaz-Cambronero, John F Bebawy, Grupo Español De Estudio Del Bloqueo Neuromuscular, Carlos L Errando, María Vila, Nuria García-Gregorio, Maria Pallardó-López, Raquel Peris, Noemí Almenara, Javier Barrio Mataix, Guillermo San Miguel Gil, Raquel Ferrandis-Comes, Juan V Llau Pitarch, Miguel Carrau Giner, Liliana P Henao, Alba Gómez Lacasa, Yolanda Jimenez Capel, Pere Vila Caral, Ana I Fernández Cortés, Raquel Alcaraz Blanco, Ignacio Armendáriz Buil, Félix Lobato Solores, Andrés García Londoño, Bernardo Martín Gil, María L Ferreira Laso, Javier Martínez Ubieto, Sonia Ortega Lucea, Ana Pascual Bellosta, Luis Muñoz Rodriguez, Francisco Romero Caro, José M López González, Bárbara M Jiménez Gómez, María Domínguez Varela, Patricia Vázquez Dopazo, Francisco J Pardo-Sobrino López, Alberto Martínez Tellería, María I Rodríguez Macías, Fanny Rodríguez Campos, Rafael F Llorente, Encarnación M Abril, Adolfo Ramos Luengo, Purificación Sánchez Zamora, Antonio García Rueda, Luisa González Pérez, Esperanza Mata, Enrique Alday Muñoz, María Orts Rodríguez, María A Santos Ampuero, Fernando Ramasco Rueda, Antonio Planas Roca, Xavier Onrubia, Julia Martín-Jaramago, Estefanía Martínez, Marta Freire Otero, Charlies Cuellar Bobadilla, Oana C Stanciu, Danilo Blanco Pieschacon, Luis E Muñoz Alameda, Lidia Padín Barreiro, Denis Pereira Matalobos, Xosé Ares Rodríguez, Gerardo Baños Rodríguez, Julián García Polit, Raúl Sainz Sánchez, Maria A González Pozo, Teresa Gómez-Pineda Puebla, Calixto Sánchez Pérez, José L Gálvez Cañellas, Luis Cueto Marcos, Manuel Á Gómez-Ríos, Eva Estévez-González, Lucía Vizcaíno-Martínez, Beatriz Izquierdo-González, Alberto Pensado-Castiñeiras, Oscar Díaz-Cambronero, Paula Pérez-Caballero, Sandra Verdeguer, Inmaculada Renart, Neus Esteve, Carlos Mora, David Fabian, Ana Ferrer, Oliva Romero, Luciano J Aguilera Celorrio, Ainhoa Renedo Fernández, Antonio Del Val MERINo, Diego Dulanto Zabala, Javier Freijo Guerrero, Almudena Reyes Fierro, Ignacio Garutti Martínez, Francisco DE LA Gala García, Ana Lajara Montell, Patricia Piñeiro Otero, Antonio M González, José M Rabanal, Bonifacio Cimadevilla, Ana Bolado, Amalia Alcón, Jaume Balust, Xavier Borrat, Raquel Risco, Ángel Caballero, Sandra Llauradó Paco, Inmaculada Camprubí Sociats, Antoni Sabaté Pes, Marta Caballero Milán, Silvia Gratz Gamarra, Daniel Robles Hernández, Miguel Vila Sánchez, Antonio Galán Cabezas, Miguel Cañuelo Cordero, Eva G Roldán Gordo, Álvaro Martín Del Pozo, Eva M Camacho Navarro, Aránzazu Puente, Ana Serrano, David Pestaña, Guido Mazzinari, Carlos L Errando, Ignacio Garutti, Guido Mazzinari, Óscar Díaz-Cambronero, John F Bebawy, Grupo Español De Estudio Del Bloqueo Neuromuscular, Carlos L Errando, María Vila, Nuria García-Gregorio, Maria Pallardó-López, Raquel Peris, Noemí Almenara, Javier Barrio Mataix, Guillermo San Miguel Gil, Raquel Ferrandis-Comes, Juan V Llau Pitarch, Miguel Carrau Giner, Liliana P Henao, Alba Gómez Lacasa, Yolanda Jimenez Capel, Pere Vila Caral, Ana I Fernández Cortés, Raquel Alcaraz Blanco, Ignacio Armendáriz Buil, Félix Lobato Solores, Andrés García Londoño, Bernardo Martín Gil, María L Ferreira Laso, Javier Martínez Ubieto, Sonia Ortega Lucea, Ana Pascual Bellosta, Luis Muñoz Rodriguez, Francisco Romero Caro, José M López González, Bárbara M Jiménez Gómez, María Domínguez Varela, Patricia Vázquez Dopazo, Francisco J Pardo-Sobrino López, Alberto Martínez Tellería, María I Rodríguez Macías, Fanny Rodríguez Campos, Rafael F Llorente, Encarnación M Abril, Adolfo Ramos Luengo, Purificación Sánchez Zamora, Antonio García Rueda, Luisa González Pérez, Esperanza Mata, Enrique Alday Muñoz, María Orts Rodríguez, María A Santos Ampuero, Fernando Ramasco Rueda, Antonio Planas Roca, Xavier Onrubia, Julia Martín-Jaramago, Estefanía Martínez, Marta Freire Otero, Charlies Cuellar Bobadilla, Oana C Stanciu, Danilo Blanco Pieschacon, Luis E Muñoz Alameda, Lidia Padín Barreiro, Denis Pereira Matalobos, Xosé Ares Rodríguez, Gerardo Baños Rodríguez, Julián García Polit, Raúl Sainz Sánchez, Maria A González Pozo, Teresa Gómez-Pineda Puebla, Calixto Sánchez Pérez, José L Gálvez Cañellas, Luis Cueto Marcos, Manuel Á Gómez-Ríos, Eva Estévez-González, Lucía Vizcaíno-Martínez, Beatriz Izquierdo-González, Alberto Pensado-Castiñeiras, Oscar Díaz-Cambronero, Paula Pérez-Caballero, Sandra Verdeguer, Inmaculada Renart, Neus Esteve, Carlos Mora, David Fabian, Ana Ferrer, Oliva Romero, Luciano J Aguilera Celorrio, Ainhoa Renedo Fernández, Antonio Del Val MERINo, Diego Dulanto Zabala, Javier Freijo Guerrero, Almudena Reyes Fierro, Ignacio Garutti Martínez, Francisco DE LA Gala García, Ana Lajara Montell, Patricia Piñeiro Otero, Antonio M González, José M Rabanal, Bonifacio Cimadevilla, Ana Bolado, Amalia Alcón, Jaume Balust, Xavier Borrat, Raquel Risco, Ángel Caballero, Sandra Llauradó Paco, Inmaculada Camprubí Sociats, Antoni Sabaté Pes, Marta Caballero Milán, Silvia Gratz Gamarra, Daniel Robles Hernández, Miguel Vila Sánchez, Antonio Galán Cabezas, Miguel Cañuelo Cordero, Eva G Roldán Gordo, Álvaro Martín Del Pozo, Eva M Camacho Navarro, Aránzazu Puente, Ana Serrano, David Pestaña, Guido Mazzinari
Abstract
Background: Residual neuromuscular blockade after general anesthesia using nondepolarizing neuromuscular blocking agents has pathophysiological, clinical, and economic consequences. A significant number of patients under muscle relaxation sustain residual curarization.
Methods: Observational, prospective, multicenter study of a cohort of patients (Residual Curarization in Spain Study, ReCuSS). Residual blockade was defined as TOFr<0.9. Patients >18 years-old under general anesthesia, including at least one dose of non-depolarizing neuromuscular blocking agents, and transferred extubated and spontaneously ventilating to the postanesthesia care unit were included. Pre- and intraoperative data were recorded, including, patient characteristics, ASA physical status, experience of the anesthesiologist, type of surgery, temperature monitoring, surgery duration, neuromuscular blockade-related parameters, type of anesthesia (halogenated-balanced, intravenous propofol-based, other), and use of neuromuscular monitoring.
Results: A total of 763 patients from 26 hospitals were included, 190 patients (26.7%) showing residual paralysis. Female patients were more prone to residual neuromuscular blockade. Length of surgery, type of relaxant used (benzylisoquinolines), halogenated anesthesia, absence of intraoperative specific monitoring, avoidance of drug reversal, and neostigmine reversal (vs. sugammadex), were significantly related to residual blockade. In the postanesthesia care unit, patients with residual neuromuscular blockade had an increased incidence of respiratory events and tracheal reintubation.
Conclusions: The incidence of residual blockade in Spain is similar to that published in other settings and countries. Female gender, longer duration of surgery, and halogenated drugs for anesthesia maintenance were related to residual paralysis, as were NMBA specific items, such as the use of benzylisoquinoline drugs, and the absence of reversal or reversal with neostigmine.
Source: PubMed