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Clinical assessment of recovery from neuromuscular blockers, is it a safe practise - An observational study

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Original Article

Author Details : Govind Shaji, Gayatri Mishra

Volume : 11, Issue : 1, Year : 2024

Article Page : 47-52

https://doi.org/10.18231/j.ijca.2024.009

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Abstract

Background: The incidence of residual neuromuscular paralysis (RNMB) with Train of four ratio<0> Materials and Methods: 100 Patients posted for surgery under general anaesthesia with endotracheal tube intubation and controlled ventilation were enrolled for the study after obtaining human ethical approval. Standard anaesthesia technique using morphine, propofol, vecuronium, isoflurane with low flow anaesthesia were administered for all patients. TOF was noted at the end of surgical procedure when patient resumed spontaneous respiration, during extubation, and at 15 minutes interval for one hour in the postoperative period. Hemodynamics were observed including respiratory rate.
Results: Overall 32 percent of patients had residual paralysis. 27% at 15 min, 26% at 30min, 6% at 45min and 3% at one hour in the postoperative period showed RNMB. Subgroup analysis showed that at the time administration of reversal 72 patients had (TOFR>0.4) and 28 had (TOFR<.0.4), showed significant difference in improvement in TOFR between 2 subgroups before reversal, immediate extubation and 15 min post extubation (p=0.00,0.001,0.003,) respectively.
Conclusion: Clinical findings of neuromuscular reversal is not foolproof for complete recovery and standard dose neostigmine given during shallow block will accentuate the residual neuromuscular paralysis.
 

Keywords: Residual paralysis, Clinical signs, Neuromuscular monitoring, Standard dose of reversal.

How to cite : Shaji G, Mishra G, Clinical assessment of recovery from neuromuscular blockers, is it a safe practise - An observational study. Indian J Clin Anaesth 2024;11(1):47-52

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