title: Postanesthesia care unit recovery times and neuromuscular blocking drugs: a prospective study of orthopedic surgical patients randomized to receive pancuronium or rocuronium.
abstract: In this study, we examined the effect of choice of neuromuscular blocking drug (NMBD) (pancuronium versus rocuronium) on postoperative recovery times and associated adverse outcomes in patients undergoing orthopedic surgical procedures. Seventy patients were randomly allocated to a pancuronium or rocuronium group. On arrival to the postanesthesia care unit (PACU) and again 30 min later, train-of-four ratios were quantified by using acceleromyography. Immediately after acceleromyographic measurements, patients were assessed for signs and symptoms of residual paresis. During the PACU admission, episodes of hypoxemia, nausea, and vomiting were recorded. The time required for patients to meet discharge criteria and the time of actual PACU discharge were noted. Forty percent of patients in the pancuronium group had train-of-four ratios <0.7 on arrival to the PACU, compared with only 5.9% of subjects in the rocuronium group (P < 0.001). Patients in the pancuronium group were more likely to experience symptoms of muscle weakness (blurry vision and generalized weakness; P < 0.001) and hypoxemia (10 patients in the rocuronium group versus 21 patients in the pancuronium group; P = 0.015) during the PACU admission. Significant delays in meeting PACU discharge criteria (50 min [45-60 min] versus 30 min [25-40 min]) and achieving actual discharge (70 min [60-90 min] versus 57.5 min [45-61 min]) were observed when the pancuronium group was compared with the rocuronium group (P < 0.001). In conclusion, our study indicates that PACU recovery times may be prolonged when long-acting NMBDs are used in surgical patients.
  
  
  CONCLUSIONS
  Clinical recovery may be delayed in surgical patients administered long-acting neuromuscular blocking drugs. During the postanesthesia care unit admission, patients randomized to receive pancuronium (versus rocuronium) were more likely to exhibit symptoms of muscle weakness, develop hypoxemia, and require more time to meet discharge criteria.
authors.affiliation: *Department of Anesthesiology, Evanston Northwestern Healthcare, Northwestern University Feinberg School of Medicine, Evanston, Illinois; and †Department of Anesthesiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
authors.forename: Glenn S
authors.initials: GS
authors.lastname: Murphy
authors.forename: Joseph W
authors.initials: JW
authors.lastname: Szokol
authors.forename: Mark
authors.initials: M
authors.lastname: Franklin
authors.forename: Jesse H
authors.initials: JH
authors.lastname: Marymont
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Avram
authors.forename: Jeffery S
authors.initials: JS
authors.lastname: Vender
mesh_terms: D000328:Adult; D000732:Androstanols; D000762:Anesthesia Recovery Period; D000768:Anesthesia, General; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D000860:Hypoxia / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D018908:Muscle Weakness / Q000453:epidemiology; D009466:Neuromuscular Blocking Agents; D003473:Neuromuscular Nondepolarizing Agents; D019637:Orthopedic Procedures; D010102:Oxygen Inhalation Therapy; D010147:Pain Measurement; D010149:Postoperative Pain / Q000453:epidemiology; D010197:Pancuronium; D011183:Postoperative Complications / Q000209:etiology*; D020250:Postoperative Nausea and Vomiting / Q000453:epidemiology / Q000517:prevention & control; D000077123:Rocuronium
chemical_list: D000732:Androstanols; D009466:Neuromuscular Blocking Agents; D003473:Neuromuscular Nondepolarizing Agents; D010197:Pancuronium; D000077123:Rocuronium