Postoperative residual curarisation: complication or malpractice?
Neuromuscular blocking drugs are often used in anaesthesia; in some types of surgery, their continuous infusion is indicated to limit the otherwise high incidence of movement. A large amount of postoperative residual curarisation is found after a single bolus, but more especially when continuous infusions are used in healthy patients and even more so in those with organ dysfunction or undergoing special types of surgery. Therefore, one should always optimise the dose requirements over time using neuromuscular transmission monitoring. Such monitoring should also help the clinician to antagonise selectively the neuromuscular block at the end of surgery. One should probably avoid routine antagonisation, especially in certain subgroups of patients, until a selective and safe reversal agent has been developed. At present, then, the only objective and reliable guide to facilitating the decision for selective antagonisation is the neuromuscular transmission monitor. Recent data and editorials warning about postoperative residual curarisation after boluses and infusions of neuromuscular blocking drugs have made residual curarisation one of the most feared complications in anaesthesia. There may be a consequent issue of malpractice if neuromuscular transmission monitoring is not used and/or pharmacological antagonisation is not performed.
Cammu
G
G
Anaesthetics and Critical Care Medicine, Onze-Lieve-Vrouw Clinic, Moorselbaan 164, B-9300 Aalst. Guy.Cammu@olvz-aalst.be
D000762:Anesthesia Recovery Period; D006801:Humans; D008318:Malpractice; D016343:Monitoring, Intraoperative; D009046:Motor Neurons / Q000187:drug effects; D009466:Neuromuscular Blocking Agents / Q000008:administration & dosage / Q000009:adverse effects* / Q000037:antagonists & inhibitors; D011183:Postoperative Complications; D009435:Synaptic Transmission / Q000187:drug effects
D009466:Neuromuscular Blocking Agents