Abstract
BackgroundInadequate neuromuscular recovery might impair pulmonary function among adult patients who undergo general anaesthesia and might thus contribute to critical respiratory events in the post-anaesthesia care unit (PACU). The pilot study aims to understand the baseline incidence of residual neuromuscular blockade (RNMB) and postoperative critical respiratory events (CREs), which are described in a modified Murphy’s criteria in the PACU.MethodThis is a prospective cohort study from January to March 2017 from a tertiary hospital in Saudi Arabia with thirty adult patients over 18 years old scheduled for elective surgery under general anaesthesia with neuromuscular blocking drugs (NMBDs) who were enrolled in the study. The Mann-Whitney U tests, chi-square tests and independent-samples T tests were used. The train-of-four (TOF) ratios were measured upon arrival in the PACU by using acceleromyography with TOF-Scan. Subjects’ demographics, perioperative data and the occurrence of postoperative CREs in the PACU were recorded.ResultsTwenty-six (86.7%) patients out of thirty in the study have received rocuronium as NMBDs whilst neostigmine as a reversal drug with only 23 (76.7%). The incidence of RNMB (TOF ratio < 0.9) was in 16 patients (53.3%). The incidence of RNMB was significantly higher in female patients (p = 0.033), in patients who had not undergone quantitative neuromuscular monitoring before extubation (p = 0.046) and in patients with a shorter duration of surgery (p = 0.001). Postoperative CREs occurred in twenty patients (66.7%), and there were significantly more of these CREs among patients with RNMB (p = 0.001). In addition, a statistically significant difference was observed in the occurrence of CREs according to body mass index (p = 0.047).ConclusionThis research showed that RNMB is a significant contributing factor to the development of critical respiratory events during PACU stay. Therefore, routine quantitative neuromuscular monitoring is recommended to reduce the incidence of RNMB.
Highlights
Many patients are at high risk of adverse events during the early postoperative period, which might be caused by anaesthetic or surgical procedures
Postoperative critical respiratory events (CREs) occurred in twenty patients (66.7%), and there were significantly more of these CREs among patients with residual neuromuscular blockade (RNMB) (p = 0.001)
Enrolment of large samples is necessary for the appropriate detection of associations with the incidence of RNMB and postoperative CREs. This is the first study conducted in Saudi Arabia that has investigated the baseline incidence of RNMB and postoperative CREs among patients undergoing elective surgery under general anaesthesia
Summary
Many patients are at high risk of adverse events during the early postoperative period, which might be caused by anaesthetic or surgical procedures. Neuromuscular blocking drugs (NMBDs) are commonly used by anaesthesiologists during general anaesthesia in order to maintain optimal surgical conditions by maintaining deep muscle relaxation and to facilitate tracheal intubation (Claudius et al 2009). The RNMB can be reliably detected through the use of neuromuscular monitoring such as train-of-four (TOF) monitoring, which is according to Murphy et al (2011) is considered one of the most commonly used approaches in clinical practice This method, is used during recovery from the application of NMBDs to objectively decide how well the patient’s muscles are able to function, which includes the application of electrical stimulation to nerves and the recording of muscle responses, called the TOF ratio (Butterworth 2013). The pilot study aims to understand the baseline incidence of residual neuromuscular blockade (RNMB) and postoperative critical respiratory events (CREs), which are described in a modified Murphy’s criteria in the PACU
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