The latest guidance in addressing proper monitoring and reversal of neuromuscular blockade drugs during general anaesthesia — a major advance in patient safety and satisfaction — was published in the journal Anesthesiology.
While neuromuscular blocking drugs aid surgery, it is important to prevent any lingering effect of the muscle relaxant, known as residual paralysis, after general anaesthesia.
The new practice guidelines are intended to help anesthesiologists reduce the likelihood of residual paralysis and include recommendations for monitoring drug effects as well as effective approaches to adequately reverse muscle relaxation.
Proper reversal of the effects of muscle relaxants helps reduce postoperative complications such as pneumonia, respiratory arrest, and reintubation, which can lead to increased time spent in the intensive care unit and the hospital.
“ASA’s evidence-based practice guidelines for the management of neuromuscular blockade during surgery will help our members and increase the safety and satisfaction of our patients,” said Michael W. Champeau, MD, Stanford Medicine, Stanford, California. “The clinical recommendations for monitoring and reversing this process will help prevent residual neuromuscular blockade so patients benefit from complete recovery, which may decrease the length of stay in the post-acute care unit and postoperative lung complications.”
The guide focuses primarily on the type and site of monitoring and the process of antagonising neuromuscular blockade to reduce residual neuromuscular blockade.
The guide recommends using quantitative neuromuscular monitoring at the adductor pollicis and to confirm a recovery of train-of-four ratio ≥0.9 before extubation. Sugammadex is recommended from deep, moderate, and shallow levels of neuromuscular blockade that is induced by rocuronium or vecuronium. Neostigmine is a reasonable alternative from minimal blockade (train-of-four ratio in the range of 0.4 to <0.9). Patients with adequate spontaneous recovery to train-of-four ratio ≥0.9 can be identified with quantitative monitoring, and these patients do not require pharmacological antagonism.