Postoperative residual block after intermediate-acting neuromuscular blocking drugs.
The frequency and duration of postoperative residual neuromuscular block on arrival of 150 patients in the recovery ward following the use of vecuronium (n = 50), atracurium (n = 50) and rocuronium (n = 50) were recorded. Residual block was defined as a train-of-four ratio of <0.8. An additional group of 10 patients received no neuromuscular blocking drugs during anaesthesia. The incidence of postoperative residual neuromuscular block was 64%, 52% and 39% after the use of vecuronium, atracurium and rocuronium, respectively. Similar numbers of patients were not able to maintain a sustained head or leg lift for 5 s on arrival in the recovery ward. The mean [range] times to attaining a train-of-four ratio of > or =0.8 after arrival in the recovery ward were 9.2 [1-61], 6.9 [1-24] and 14.7 [1.5-83] min for vecuronium, atracurium and rocuronium, respectively. None of the 10 patients who did not receive neuromuscular blocking drugs had train-of-four ratios <0.8 on arrival in the recovery ward. It is concluded that a large proportion of patients arrive in the recovery ward with a train-of-four ratio <0.8, even with the use of intermediate-acting neuromuscular blocking drugs. Although the residual block is relatively short lasting, it may occasionally be prolonged, requiring close observation and monitoring of such patients in the recovery ward.
Hayes
A H
AH
Department of Anaesthetics and Intensive Care Medicine, The Queen's University of Belfast, Whitla Medical Building, 97 Lisburn Road, Belfast BT9 7BL, UK.
Mirakhur
R K
RK
Breslin
D S
DS
Reid
J E
JE
McCourt
K C
KC
D000293:Adolescent; D000328:Adult; D000368:Aged; D000732:Androstanols / Q000037:antagonists & inhibitors / Q000494:pharmacology; D000762:Anesthesia Recovery Period; D001279:Atracurium / Q000037:antagonists & inhibitors / Q000494:pharmacology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods; D019148:Neuromuscular Blockade; D009469:Neuromuscular Junction / Q000187:drug effects* / Q000502:physiology; D003473:Neuromuscular Nondepolarizing Agents / Q000037:antagonists & inhibitors / Q000494:pharmacology*; D000077123:Rocuronium; D014673:Vecuronium Bromide / Q000037:antagonists & inhibitors / Q000494:pharmacology
D000732:Androstanols; D003473:Neuromuscular Nondepolarizing Agents; D001279:Atracurium; D014673:Vecuronium Bromide; D000077123:Rocuronium