Management Principles to Reduce the Risk of Residual Neuromuscular Blockade

Abstract

The perioperative use of neuromuscular blocking agents has revolutionized medicine, and has allowed numerous and significant advances in the surgical management of patients. However, surgical advancement has not been devoid of attendant complications such as intraoperative patient recall, residual neuromuscular weakness, pulmonary aspiration of gastric contents, and need for tracheal reintubation. This chapter briefly reviews the various ways in which clinicians can optimize the timing and dosing of muscle relaxants, improve perioperative monitoring of muscle relaxation, and enhance the pharmacologic reversal of neuromuscular block. These strategies are intended to reduce the incidence of postoperative neuromuscular weakness and improve the safety of patients undergoing surgery and general anesthesia.