Relajación residual postoperatoria en la unidad de cuidados postanestésicos de un hospital universitario: estudio de corte transversal

Abstract

IntroductionPostoperative residual paralysis has been related with postoperative complications. ObjectiveTo determine the prevalence of postoperative residual paralysis in a university hospital and its association with perioperative conditions. MethodsA prospective registry of 102 patients in a period of 4 months was designed to include ASA I-II patients who intraoperatively received nondepolarizing neuromuscular blockers. Abductor pollicis response to a train-of-four stimuli based on accelleromyography and thenar eminence temperature (TOF-Watch SX®. Organon, Ireland) was measured immediately upon arrival to the postanesthetic care unit and 30seconds after. Uni-bivariate analysis were planned to determine possible associations with residual paralysis, defined as two repeated values of T4/T1 ratio <0.90 in response to train-of-four stimuli. ResultsPostoperative residual paralysis was detected in 42.2% of the subjects. Pancuronium was associated with a high risk for train-of-four response<0.9 at the arrive to postoperative care unit (RR:2.56 [IC95% 1.99-3.30]; p=0.034). A significant difference in thenar temperature (°C) was found in subjects with train-of-four<0.9 when compared to those who reach adecuate neuromuscular function (29.9±1.6 vs. 31.1±2.2; respectively. p=.003). However we were unable to demonstrate a direct atribution of findings in train-of-four response to temperature (R2 determination coefficient=0.08%). ConclusionA high prevalence of postoperative residual paralysis persists in university hospitals despite a reduced use of long lasting neuromuscular blockers. Strategies to assure neuromuscular monitoring practice and access to therapeutic alternatives in this setting must be considered. Intraoperative neuromuscular blockers using algorithms and continued education in this field must be priorities of Anesthesia services.