[Monitoring of neuromuscular block and prevention of residual paralysis].
Neuromuscular monitoring and routine use of reversal agents are key elements in the prevention of residual paralysis. According to a nation-wide survey up to 52 % of anaesthesiologists in France apply regularly neuromuscular monitoring after a single intubating dose of a neuromuscular blocking agent and 74 % in case of repetitive administration. However, reversal is rather the exception than routine and, still according to this survey, the risk of residual paralysis largely underestimated. The development of a new class of reversal agents (cyclodextrins) may further modify the management of neuromuscular blockade in clinical practice. The article aims to revise the principles of neuromuscular monitoring and evaluate whether its use is still mandatory when sugammadex is used.
Fuchs-Buder
T
T
Service d'Anesthésie-Réanimation Chirurgicale, Hôpitaux de Brabois, CHU de Nancy, rue du Morvan, 54500 Vandoeuvre, France. t.fuchs-buder@chu-nancy.fr
Meistelman
C
C
D000762:Anesthesia Recovery Period; D018680:Cholinergic Antagonists / Q000627:therapeutic use; D003505:Cyclodextrins / Q000627:therapeutic use*; D020878:Device Removal; D004568:Electrodiagnosis / Q000379:methods*; D019416:Head Movements; D006801:Humans; D015994:Incidence; D007442:Intubation, Intratracheal; D008991:Monitoring, Physiologic / Q000379:methods*; D018482:Muscle, Skeletal / Q000294:innervation / Q000503:physiopathology; D019148:Neuromuscular Blockade / Q000009:adverse effects*; D003473:Neuromuscular Nondepolarizing Agents / Q000009:adverse effects* / Q000494:pharmacology; D010525:Peripheral Nerves / Q000187:drug effects / Q000503:physiopathology; D011183:Postoperative Complications / Q000139:chemically induced / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology / Q000517:prevention & control*; D012133:Respiratory Paralysis / Q000139:chemically induced / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology / Q000517:prevention & control*; D012680:Sensitivity and Specificity; D014059:Tongue / Q000503:physiopathology
D018680:Cholinergic Antagonists; D003505:Cyclodextrins; D003473:Neuromuscular Nondepolarizing Agents