Global InformationPostoperative residual curarization information
| Postoperative residual curarization | |
|---|---|
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| Electromyographic monitoring at the adductor policies muscle. | |
| Specialty | Anesthesia |
Postoperative residual curarization (PORC) or residual neuromuscular blockade (RNMB) is a residual paresis after emergence from general anesthesia that may occur with the use of neuromuscular-blocking drugs.[1][2] Today residual neuromuscular blockade is defined as a train of four ratio[3] of less than 0.9 when measuring the response to ulnar nerve stimulation at the adductor pollicis muscle using mechanomyography or electromyography.[4] A meta-analysis reported that the incidence of residual neuromuscular paralysis was 41% in patients receiving intermediate neuromuscular blocking agents during anaesthesia.[1] It is possible that > 100,000 patients annually in the USA alone, are at risk of adverse events associated with undetected residual neuromuscular blockade.[5] Neuromuscular function monitoring and the use of the appropriate dosage of sugammadex to reverse blockade produced by rocuronium can reduce the incidence of postoperative residual curarization.[6] In this study, with usual care group receiving reversal with neostigmine resulted in a residual blockade rate of 43%.[citation needed]
- ^ a b Naguib M, Kopman AF, Ensor JE (2007). "Neuromuscular monitoring and postoperative residual curarisation: a meta-analysis". Br J Anaesth. 98 (3): 302–316. doi:10.1093/bja/ael386. PMID 17307778.
- ^ Baillard C (2005). "Postoperative residual neuromuscular block: a survey of management". Br J Anaesth. 95 (5): 622–626. doi:10.1093/bja/aei240. PMID 16183681.
- ^ Ortega R, Brull SJ, Prielipp R, Gutierrez A, De La Cruz R, Conley CM (2018-01-25). "Monitoring Neuromuscular Function". New England Journal of Medicine. 378 (4): e6. doi:10.1056/nejmvcm1603741. ISSN 0028-4793. PMID 29365307.
- ^ Naguib M, Brull SJ, Johnson KB (2017). "Conceptual and technical insights into the basis of neuromuscular monitoring". Anaesthesia. 72 (S1): 16–37. doi:10.1111/anae.13738. ISSN 1365-2044. PMID 28044330.
- ^ Brull SJ, Naguib M, Miller RD (2008). "Residual Neuromuscular Block: Rediscovering the Obvious". Anesthesia & Analgesia. 107 (1): 11–14. doi:10.1213/ane.0b013e3181753266. ISSN 0003-2999. PMID 18635461.
- ^ Brueckmann B, Sasaki N, Grobara P, Li MK, Woo T, de Bie J, Maktabi M, Lee J, Kwo J (November 2015). "Effects of sugammadex on incidence of postoperative residual neuromuscular blockade: a randomized, controlled study". British Journal of Anaesthesia. 115 (5): 743–751. doi:10.1093/bja/aev104. ISSN 0007-0912. PMID 25935840.