title: Postoperative residual neuromuscular block: a survey of management.
abstract: BACKGROUND
  To avoid postoperative residual neuromuscular block there is a need for a change in clinician's attitude towards monitoring and reversal. This study aims to evaluate changes of perioperative neuromuscular block management during the last decade in our institution and to quantify the incidence of postoperative residual neuromuscular block.
  
  
  METHODS
  Patients receiving intermediate-acting neuromuscular blocking agents for scheduled surgical procedures during 3-month periods in 1995 (n=435), 2000 (n=130), 2002 (n=101), and in 2004 (n=218) were prospectively and successively enrolled in our study. The management of neuromuscular block in the operating room and the adequacy of the recovery were at the discretion of the anaesthesiologist. An attempt was made between each study period to promote a change in the management of neuromuscular block. In the post-anaesthesia care unit, train-of-four (TOF) stimulations were used to assess the presence of a residual neuromuscular block.
  
  
  RESULTS
  Between 1995 and 2004 quantitative measurement and reversal of neuromuscular block in the operating room increased from 2 to 60% and from 6 to 42%, respectively (P<0.001). During the same time, the incidence of residual neuromuscular block defined as a TOF ratio less than 0.9 decreased from 62 to 3% (P<0.001). Use of objective neuromuscular monitoring and/or anticholinesterase drugs was less likely in patients with an inadequate recovery (P<0.001).
  
  
  CONCLUSIONS
  During the last decade the incidence of residual neuromuscular block strongly decreased in our institution. It confirms the positive impact of neuromuscular monitoring and reversal of neuromuscular block in routine anaesthetic practice.
authors.affiliation: Département d'Anesthésie-Réanimation, EA 3409, Hôpital Avicenne, APHP, 93009 Bobigny Cedex, France. christophe.baillard@avc.ap-hop-paris.fr
authors.forename: C
authors.initials: C
authors.lastname: Baillard
authors.forename: C
authors.initials: C
authors.lastname: Clec'h
authors.forename: J
authors.initials: J
authors.lastname: Catineau
authors.forename: F
authors.initials: F
authors.lastname: Salhi
authors.forename: G
authors.initials: G
authors.lastname: Gehan
authors.forename: M
authors.initials: M
authors.lastname: Cupa
authors.forename: C M
authors.initials: CM
authors.lastname: Samama
mesh_terms: D000328:Adult; D000368:Aged; D000762:Anesthesia Recovery Period; D001291:Attitude of Health Personnel; D016903:Drug Monitoring / Q000706:statistics & numerical data; D004558:Electric Stimulation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000706:statistics & numerical data; D019148:Neuromuscular Blockade / Q000379:methods; D009466:Neuromuscular Blocking Agents / Q000037:antagonists & inhibitors / Q000494:pharmacology*; D009469:Neuromuscular Junction / Q000187:drug effects* / Q000502:physiology; D011183:Postoperative Complications / Q000517:prevention & control*; D011364:Professional Practice / Q000639:trends
chemical_list: D009466:Neuromuscular Blocking Agents