[Reversal from non-depolarising neuromuscular blockade in the postoperative period].
BACKGROUND
Postoperative residual curarisation (PORC) is a serious and underestimated problem and may occur even after relaxation with medium-acting non-depolarising agents.


METHODS
One hundred adult patients, scheduled for elective surgical procedures, were enrolled in the study. Atracurium or cis-atracurium was used for relaxation. Neostigmine was administered for reversal at the end of surgery, at the discretion of the attending anaesthesiologist. Neuromuscular transmission was not monitored in the operating room. In the recovery room, the presence of residual block was assessed by a blinded investigator using accelerometry (TOF-Guard, Organon, Holland) immediately after arrival (T-A) and after 45 min (T-B). Those who received neostigmine were allocated to group I (49 patients), and those who did not were allocated to group II (51 patients).


RESULTS
The mean duration of anaesthesia was 92 min in group I and 103 min in group II. The respective doses of atracurium were 78.2 and 72.0 mg; and of cis-atracurium--17.6 mg and 18.0 mg. Immediately after arrival, a TOF below 0.7 was detected in 26% of patients, and below 0.9 in 48% of patients. After forty-five minutes the TOF was still below 0.7 in one patient and below 0.9 in seven. The number of patients with residual block (TOF<0.9) did not differ statistically between those who received neostigmine and those who did not (3.92% and 10.2%, respectively).


CONCLUSIONS
The clinical assessment of neuromuscular blockade reversal did not allow for detection of PORC. Neostigmine was not fully effective in reversal.
Gaszyński
Tomasz
T
Klinika Anestezjologii i Intensywnej Terapii UM w Łodzi. tomgaszyn@hotmail.com
Szlachciński
Lukasz
L
Jakubiak
Jakub
J
Gaszyński
Wojciech
W
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000762:Anesthesia Recovery Period; D001279:Atracurium / Q000009:adverse effects* / Q000037:antagonists & inhibitors; D002800:Cholinesterase Inhibitors / Q000627:therapeutic use*; D017558:Elective Surgical Procedures; D004558:Electric Stimulation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009388:Neostigmine / Q000627:therapeutic use*; D009469:Neuromuscular Junction / Q000187:drug effects* / Q000503:physiopathology; D003473:Neuromuscular Nondepolarizing Agents / Q000009:adverse effects* / Q000037:antagonists & inhibitors; D019635:Neurosurgical Procedures; D020127:Recovery of Function; D013997:Time Factors; D014459:Ulnar Nerve; D055815:Young Adult
D002800:Cholinesterase Inhibitors; D003473:Neuromuscular Nondepolarizing Agents; D001279:Atracurium; D009388:Neostigmine