keyword
https://read.qxmd.com/read/38337560/residual-neuromuscular-block-remains-a-safety-concern-for-perioperative-healthcare-professionals-a-comprehensive-review
#1
REVIEW
Franziska Elisabeth Blum, Andrew R Locke, Naveen Nathan, Jeffrey Katz, David Bissing, Mohammed Minhaj, Steven B Greenberg
Residual neuromuscular block (RNMB) remains a significant safety concern for patients throughout the perioperative period and is still widely under-recognized by perioperative healthcare professionals. Current literature suggests an association between RNMB and an increased risk of postoperative pulmonary complications, a prolonged length of stay in the post anesthesia care unit (PACU), and decreased patient satisfaction. The 2023 American Society of Anesthesiologists Practice Guidelines for Monitoring and Antagonism of Neuromuscular Blockade provide guidance for the use of quantitative neuromuscular monitoring coupled with neuromuscular reversal to recognize and reduce the incidence of RNMB...
February 1, 2024: Journal of Clinical Medicine
https://read.qxmd.com/read/38264400/residual-neuromuscular-blockade-and-postoperative-pulmonary-complications-in-the-post-anesthesia-care-unit-a-prospective-observational-study
#2
JOURNAL ARTICLE
Buthaina A Bucheery, Hasan M Isa, Owais Rafiq, Nada Abdulrahman Almansoori, Zaina Abdulsatar Abdul Razaq, Zeana A Gawe, Jihad Ali Almoosawi
Background Neuromuscular blocking agents (NMBAs) are employed during general anesthesia induction for endotracheal intubation and to facilitate specific surgeries requiring muscle relaxation. However, residual neuromuscular blockade (RNMB) can lead to respiratory complications in post-anesthesia care units (PACUs). This study investigates RNMB incidence in PACUs and its association with postoperative airway and respiratory issues. Methods A prospective observational study on patients undergoing general anesthesia with NMBAs was conducted at the Department of Anesthesia, Salmaniya Medical Complex, Bahrain, over six months (April to September 2023)...
December 2023: Curēus
https://read.qxmd.com/read/37547706/incidence-of-postoperative-residual-neuromuscular-blockade-a-multicenter-observational-study-in-portugal-inspire-2
#3
JOURNAL ARTICLE
Simão Esteves, Filinto Correia de Barros, Catarina S Nunes, Andreia Puga, Blandina Gomes, Fernando Abelha, Humberto Machado, Milene Ferreira, Nuno Fernandes, Paula Vítor, Sandra Pereira, Teresa A Lapa, Vítor Pinho-Oliveira
BACKGROUND: Although the use of neuromuscular blocking agents (NMBAs) optimizes surgical conditions and facilitates tracheal intubation, it can lead to residual neuromuscular blockade (RNMB), with postoperative complications. This study aimed to assess RNMB incidence and management in Portugal. METHODS: Prospective observational study of patients admitted for elective surgery requiring general anesthesia with nondepolarizing NMBAs between July 2018 and July 2019 at 10 Portuguese hospitals...
2023: Porto Biomedical Journal
https://read.qxmd.com/read/37005560/rate-of-residual-neuromuscular-block-using-single-dose-rocuronium-in-general-anesthesia-for-ent-surgery-a-retrospective-cohort-study
#4
JOURNAL ARTICLE
Orlando Carrillo Torres, María Guadalupe Pliego Sánchez, Víctor Joshua Pérez Muñoz, Jennifer Sánchez Jurado, Verónica Camacho Vacherón, José Damián Carrillo Ruiz
INTRODUCTION: NMB facilitates intubating conditions in general anesthesia. However, it is associated with significant residual postoperative paralysis and morbidity. OBJECTIVE: To investigate the rate of underdiagnosed residual NMB based on two TOFR criteria (< 0.91 and < 1.00). METHODS: We performed a retrospective study adhering to STROBE guidelines. We included patients undergoing ENT surgery using single-dose neuromuscular block for balanced general anesthesia from June to December 2018...
April 1, 2023: BMC Anesthesiology
https://read.qxmd.com/read/36611181/routine-administration-of-neostigmine-after-recovery-of-spontaneous-breathing-versus-neuromuscular-monitor-guided-administration-of-neostigmine-in-pediatric-patients-a-parallel-randomized-controlled-study
#5
JOURNAL ARTICLE
Lei Yang, Na Hu, Hong Chang, Di Yang, Yunxia Zuo
BACKGROUND: Neostigmine used to reverse the muscle relaxants should be guided by neuromuscular monitoring, as the degree of spontaneous pre-reversal recovery is the key to success to reverse the neuromuscular block. But neuromuscular monitoring is not always available for some patients during anesthesia and, in consequence, we need to use other clinical judgment to guide the use of neostigmine to reverse the neuromuscular block. In this trial, we aimed to evaluate the incidence of residual neuromuscular blockade (rNMB) in pediatric patients with routine use of neostigmine after recovery of spontaneous breathing compared with the patients with the use of neostigmine guided by neuromuscular monitoring...
January 7, 2023: Trials
https://read.qxmd.com/read/36422506/residual-neuromuscular-block-in-the-postanesthesia-care-unit-incidence-risk-factors-and-effect-of-neuromuscular-monitoring-and-reversal-agents
#6
JOURNAL ARTICLE
Nazlı Bahar Özbey, Taner Abdullah, Özlem Deligöz
BACKGROUND: The aim of this study was to determine the incidence of residual neuromuscular block (RNMB) in a tertiary care hospital. Secondary goals were to examine the characteristics of the use of intraoperative neuromuscular monitoring (NMM) and different reversal agents by the attending anesthesiologists, and to determine the factors related to the patient and perioperative processes on the development of RNMB. METHODS: The patients' arrival time at the postanesthesia care unit was accepted as point zero (T0)...
October 2022: Turkish Journal of Medical Sciences
https://read.qxmd.com/read/34784457/the-use-of-sugammadex-in-an-infant-with-prolonged-neuromuscular-blockade-a-case-report
#7
Hyunho Kim, Joonho Cho, Sangseok Lee, Yunhee Lim, Byunghoon Yoo
BACKGROUND: Residual neuromuscular blockade (RNMB) is a frequent event after general anesthesia, which can lead to serious complications, such as upper airway obstruction. Sugammadex is useful in reversing RNMB. However, its use in infants has not yet been approved by the Food and Drug Administration. Therefore, anesthesiologists can be hesitant use it, even in situations where no other choice is available. CASE: A two-month-old baby presented to the hospital for umbilical polypectomy...
January 2022: Anesthesia and pain medicine
https://read.qxmd.com/read/33941287/the-association-between-residual-neuromuscular-blockade-rnmb-and-critical-respiratory-events-a-prospective-cohort-study
#8
JOURNAL ARTICLE
Faraj K Alenezi, Khalid Alnababtah, Mohammed M Alqahtani, Lafi Olayan, Mohammed Alharbi
BACKGROUND: Inadequate 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. METHOD: This 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...
May 4, 2021: Perioperative Medicine
https://read.qxmd.com/read/33188600/economic-analysis-of-sugammadex-versus-neostigmine-for-reversal-of-neuromuscular-blockade-for-laparoscopic-surgery-in-china
#9
JOURNAL ARTICLE
Maodong Ren, Ying Wang, Yan Luo, Jia Fang, Yongji Lu, Jianwei Xuan
BACKGROUND: Neuromuscular blockade and pneumoperitoneum (PP) are important factors to ensure successful laparoscopic surgery. However, residual neuromuscular blockade (rNMB) and PP are associated with many unfavorable complications. The aim of this study is to compare the cost-effectiveness of using sugammadex versus neostigmine in laparoscopic surgery in China. METHODS: A decision tree model was developed with a time horizon based on laparoscopic surgery related hospitalization duration...
November 14, 2020: Health Economics Review
https://read.qxmd.com/read/32585565/epidemiology-and-outcomes-of-residual-neuromuscular-blockade-a-systematic-review-of-observational-studies
#10
REVIEW
Amit D Raval, Vamshi Ruthwik Anupindi, Cheryl P Ferrufino, Diana L Arper, Lori D Bash, Sorin J Brull
OBJECTIVES: Complete reversal of neuromuscular blockade (NMB) is important for patient safety and prognosis following surgical procedures involving NMB agents (NMBAs). Published evidence on the epidemiology and consequences of residual neuromuscular blockade (rNMB; incomplete neuromuscular recovery) in real-world clinical settings is lacking with advances in NMB management. Therefore, we aimed to examine the burden of rNMB and its associated clinical, economic and humanistic outcomes using a systematic review framework...
November 2020: Journal of Clinical Anesthesia
https://read.qxmd.com/read/32304958/incidence-of-residual-neuromuscular-blockade-and-use-of-neuromuscular-blocking-agents-with-or-without-antagonists-a-systematic-review-and-meta-analysis-of-randomized-controlled-trials
#11
JOURNAL ARTICLE
Amit D Raval, Jennifer Uyei, Andreas Karabis, Lori D Bash, Sorin J Brull
OBJECTIVES: Neuromuscular blocking agents (NMBAs) have revolutionized the field of anesthesiology as they facilitate airway management and ensure optimal surgical conditions. Despite their beneficial and ubiquitous use during surgery, delayed or partial recovery from NMBAs, referred to as residual neuromuscular block (rNMB), is a common clinical problem. While it is well accepted that the antagonist sugammadex, compared to neostigmine, can more rapidly reverse rocuronium-induced NMB regardless of depth of block, the occurrence of rNMB for routinely used combinations of NMBAs with sugammadex or neostigmine has not yet been quantified or evaluated systematically...
April 15, 2020: Journal of Clinical Anesthesia
https://read.qxmd.com/read/31390986/usefulness-of-intra-operative-neuromuscular-blockade-monitoring-and-reversal-agents-for-postoperative-residual-neuromuscular-blockade-a-retrospective-observational-study
#12
JOURNAL ARTICLE
Gonzalo Domenech, Matías A Kampel, María E García Guzzo, Delfina Sánchez Novas, Sergio A Terrasa, Gustavo Garcia Fornari
BACKGROUND: Complete avoidance of residual neuromuscular blockade (RNMB) during the postoperative period has not yet been achieved in current anesthesia practice. Evidently, compliance with NMB monitoring is persistently low, and the risk of RNMB during the perioperative period remains underestimated. To our knowledge, no publications have reported the incidence of RNMB in a university hospital where access to quantitative NMB monitoring and sugammadex is unlimited and where NMB management is not protocolised...
August 7, 2019: BMC Anesthesiology
https://read.qxmd.com/read/31303710/a-multicenter-survey-on-the-use-of-neuromuscular-blockade-in-greece-does-the-real-world-clinical-practice-indicate-the-necessity-of-guidelines
#13
JOURNAL ARTICLE
Chrysanthi Batistaki, Kyriaki Vagdatli, Adelais Tsiotou, Alexandra Papaioannou, Aggeliki Pandazi, Paraskevi Matsota
Background and Aims: The aim of this study was to investigate the current status of clinical practice regarding neuromuscular blocking drugs and their antagonists in Greece. Material and Methods: This is a multicenter survey, including a questionnaire based on previous studies, which was translated and modified by a Task Force of the Hellenic Society of Anaesthesiology. It was completed on a web-based database after invitation via e-mail and was left online for a period of 2 months...
April 2019: Journal of Anaesthesiology, Clinical Pharmacology
https://read.qxmd.com/read/30594097/incidence-risk-factors-and-consequences-of-residual-neuromuscular-block-in-the-united-states-the-prospective-observational-multicenter-recite-us-study
#14
MULTICENTER STUDY
Leif Saager, Eric M Maiese, Lori D Bash, Tricia A Meyer, Harold Minkowitz, Scott Groudine, Beverly K Philip, Pedro Tanaka, Tong Joo Gan, Yiliam Rodriguez-Blanco, Roy Soto, Olaf Heisel
STUDY OBJECTIVE: To determine the incidence burden and associated risk factors of residual neuromuscular block (rNMB) during routine U.S. hospital care. DESIGN: Blinded multicenter cohort study. SETTING: Operating and recovery rooms of ten community and academic U.S. hospitals. PATIENTS: Two-hundred fifty-five adults, ASA PS 1-3, underwent elective abdominal surgery with general anesthesia and ≥1 dose of non-depolarizing neuromuscular blocking agent (NMBA) for endotracheal intubation and/or maintenance of NMB between August 2012 and April 2013...
August 2019: Journal of Clinical Anesthesia
https://read.qxmd.com/read/30020144/comparison-of-a-novel-clinical-score-to-estimate-the-risk-of-residual-neuromuscular-block-prediction-score-and-the-last-train-of-four-count-documented-in-the-electronic-anaesthesia-record-a-retrospective-cohort-study-of-electronic-data-on-file
#15
JOURNAL ARTICLE
Maíra I Rudolph, Pauline Y Ng, Hao Deng, Flora T Scheffenbichler, Stephanie D Grabitz, Jonathan P Wanderer, Timothy T Houle, Matthias Eikermann
BACKGROUND: Residual neuromuscular block (rNMB) after surgery is not difficult to identify if proper neuromuscular monitoring is used, but many clinicians do not use quantitative neuromuscular monitoring. OBJECTIVE: The aim of this study was to develop a REsidual neuromuscular block Prediction Score (REPS) to predict postoperative rNMB and compare the predictive accuracy of the prediction score with train-of-four count (TOFC) measurement at the end of a surgical case...
November 2018: European Journal of Anaesthesiology
https://read.qxmd.com/read/29843504/initial-experience-with-the-unrestricted-introduction-of-sugammadex-at-a-large-academic-medical-center-a-retrospective-observational-study-examining-postoperative-mechanical-ventilation-and-efficiency-outcomes
#16
JOURNAL ARTICLE
Vikas N O'Reilly-Shah, Grant C Lynde, Matthew L Mitchell, Carla L Maffeo, Craig S Jabaley, Francis A Wolf
BACKGROUND: Sugammadex rapidly reverses deep neuromuscular blockade, but owing to cost, questions remain about its optimal utilization. After the unrestricted introduction of sugammadex at Emory University Hospital, we hypothesized that reductions would be demonstrated in the primary outcome of post-anesthesia care unit (PACU) mechanical ventilation (MV) and secondary outcomes of PACU length of stay (LOS) and emergence time (surgery end to anesthesia end time in the PACU). METHODS: This retrospective observational study included patients undergoing general anesthesia over a 12-month period...
October 2018: Korean Journal of Anesthesiology
https://read.qxmd.com/read/27871520/cisatracurium-and-rocuronium-associated-residual-neuromuscular-dysfunction-under-intraoperative-neuromuscular-monitoring-and-postoperative-neostigmine-reversal-a-single-blind-randomized-trial
#17
RANDOMIZED CONTROLLED TRIAL
Paolo Feltracco, Tommaso Tonetti, Stefania Barbieri, Anna Chiara Frigo, Carlo Ori
BACKGROUND: Postoperative residual neuromuscular blockade (RNMB) is a common complication in the postanesthesia care unit (PACU), but also one of the most controversial issues. Many studies and trials demonstrated that some methods and techniques can reduce the incidence and the extent of the phenomenon. STUDY OBJECTIVE: To determine the incidence of RNMB in the PACU at standardized times after extubation with the implementation of a protocol of careful neuromuscular blockade management...
December 2016: Journal of Clinical Anesthesia
https://read.qxmd.com/read/27852231/a-discrete-event-simulation-model-of-clinical-and-operating-room-efficiency-outcomes-of-sugammadex-versus-neostigmine-for-neuromuscular-block-reversal-in-canada
#18
COMPARATIVE STUDY
Ralph P Insinga, Cédric Joyal, Alexandra Goyette, André Galarneau
BACKGROUND: The objective of this analysis is to explore potential impact on operating room (OR) efficiency and incidence of residual neuromuscular blockade (RNMB) with use of sugammadex (Bridion™, Merck & Co., Inc., Kenilworth, NJ USA) versus neostigmine for neuromuscular block reversal in Canada. METHODS: A discrete event simulation (DES) model was developed to compare ORs using either neostigmine or sugammadex for NMB reversal over one month. Selected inputs included OR procedure and turnover times, hospital policies for paid staff overtime and procedural cancellations due to OR time over-run, and reductions in RNMB and associated complications with sugammadex use...
November 16, 2016: BMC Anesthesiology
https://read.qxmd.com/read/27832563/comparison-of-kinemyography-and-electromyography-during-spontaneous-recovery-from-non-depolarising-neuromuscular-blockade
#19
COMPARATIVE STUDY
C Khandkar, S Liang, S Phillips, C Y Lee, P A Stewart
This study compared two commercially available quantitative neuromuscular function monitoring techniques, kinemyography (KMG) and electromyography (EMG), to assess whether KMG could be used interchangeably with EMG to exclude residual neuromuscular blockade (RNMB). Train-of-four (TOF) ratios were recorded every 20 seconds using KMG at the adductor pollicis and EMG at the first dorsal interosseous of the same hand during spontaneous recovery from shallow neuromuscular blockade. TOF ratios were compared using Bland-Altman analysis for repeated measurements...
November 2016: Anaesthesia and Intensive Care
https://read.qxmd.com/read/27818682/current-trends-in-neuromuscular-blockade-management-and-monitoring-amongst-singaporean-anaesthetists
#20
JOURNAL ARTICLE
Wendy H Teoh, Thomas Ledowski, Phillip S Tseng
Introduction . This survey aimed to investigate the attitudes/practice pertaining the use, management, and monitoring of neuromuscular blockade amongst Singaporean anaesthetists. Methods . All specialist accredited anaesthetists registered with the Singapore Medical Council were invited to complete an anonymous online survey. Results . The response rate was 39.5%. Neuromuscular monitoring (NM) was used routinely by only 13.1% despite the widespread availability of monitors. 82% stated residual NMB (RNMB) was a significant risk factor for patient outcome, but only 24% believed NMB monitoring should be compulsory in all paralyzed patients...
2016: Anesthesiology Research and Practice
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