What is the role of neuromuscular blocking drugs in ambulatory anesthesia?
OBJECTIVE
During ambulatory anesthesia, muscle relaxants should be used judiciously because of their impact on operating room efficiency and the potential for morbidity and mortality.


RESULTS
Short-acting and low doses of medium-acting muscle relaxants are appropriate for the typically short period of anesthesia required in ambulatory settings, but they are not necessarily indicated. Their adverse effects range from annoying to lethal. Even when the effects are relatively benign, delays may reduce efficiency. Direct laryngoscopy and endotracheal intubation can often safely be accomplished with opioids and propofol, or with topical anesthesia. Procedures such as laparoscopic cholecystectomies can safely be performed with anesthesia via a laryngeal mask airway; with other procedures, a regional technique or monitored anesthesia care is satisfactory. New agents may improve upon currently available muscle relaxants in terms of rapid onset, short duration, and minimal adverse effects.


CONCLUSIONS
Anesthetic and surgical needs should dictate the use of muscle relaxants, and alternatives to their use should be considered.
Cutter
Thomas W
TW
University of Chicago, Chicago, Illinois 60637, USA. tcutter@airway.uchicago.edu