Neuromuscular monitoring: old issues, new controversies.
"Expert" editorial opinion suggests that objective or quantitative neuromuscular monitors should be used whenever nondepolarizing blocking agents are administered. It is clear that this advice has by and large fallen on deaf ears. A sizeable number of clinicians here (North America) and abroad (Europe) fail to use even conventional peripheral nerve stimulators routinely. This chapter will explore potential reasons for and consequences of this disconnect between academia and "the real world." Along the way, we will examine such questions as how do we define and measure adequate recovery from nondepolarizing block. What are the limitations of clinical tests of recovery such as the "head-lift test?" What is the incidence of undetected postoperative residual curarization (PORC)? Does neuromuscular monitoring reduce the frequency of PORC? How will the availability of sugammadex alter the above discussion?
Kopman
Aaron F
AF
Weill Cornell Medical College, New York, NY 10021, USA. akopman@nyc.rr.com
D000762:Anesthesia Recovery Period; D000776:Anesthesiology / Q000379:methods* / Q000592:standards / Q000639:trends; D016903:Drug Monitoring / Q000379:methods* / Q000592:standards / Q000639:trends; D004558:Electric Stimulation / Q000379:methods; D004576:Electromyography; D005071:Evoked Potentials / Q000187:drug effects; D005544:Forecasting; D019983:Guideline Adherence; D006801:Humans; D016343:Monitoring, Intraoperative / Q000379:methods* / Q000592:standards / Q000639:trends; D019148:Neuromuscular Blockade / Q000009:adverse effects / Q000379:methods; D003473:Neuromuscular Nondepolarizing Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000037:antagonists & inhibitors; D010366:Peak Expiratory Flow Rate / Q000187:drug effects; D017410:Practice Guidelines as Topic; D015656:Respiratory Mechanics / Q000187:drug effects; D016896:Treatment Outcome; D014797:Vital Capacity / Q000187:drug effects
D003473:Neuromuscular Nondepolarizing Agents