[Incidence and complications of post operative residual paralysis].
A 0.9 train-of-four ratio, measured at the thumb, is currently considered to reflect adequate recovery of neuromuscular block. Recent studies have documented that a train-of-four ratio <0.9 is associated with a decrease in chemoreceptor sensitivity to hypoxia and with a functional impairment of the pharyngeal muscles. These residual effects of neuromuscular blocking agents promote insufficient ventilatory response to hypoxia and regurgitation/aspiration. As a result, the incidence of pulmonary complications have been found to be higher in both early and late postoperative period in patients with residual curarisation. Clinical tests such as the head lift test and visual or tactile evaluation of the response to peripheral nerve stimulation are no longer sufficient to exclude postoperative residual curarisation. Residual curarisation is still present at the time of extubation despite the use of subject if monitoring of neuromuscular function, clinical tests and/or reversal of neuromuscular blocking agents. In contrast, acceleromyographic monitoring provides a valuable tool to avoid residual curarisation and to reduce the related-side effects.
Baillard
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Service d'Anesthésie-Réanimation, Unité de Surveillance Continue-Réanimation, CHU Avicenne, EA 3409, 93009 Bobigny. christophe.baillard@avc.aphp.fr
D000762:Anesthesia Recovery Period; D002344:Carotid Body / Q000503:physiopathology; D003505:Cyclodextrins / Q000494:pharmacology / Q000627:therapeutic use; D020878:Device Removal; D004568:Electrodiagnosis / Q000379:methods; D006801:Humans; D000860:Hypoxia / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control; D015994:Incidence; D007442:Intubation, Intratracheal; D008991:Monitoring, Physiologic / Q000379:methods; D019148:Neuromuscular Blockade / Q000009:adverse effects*; D003473:Neuromuscular Nondepolarizing Agents / Q000009:adverse effects* / Q000494:pharmacology; D010609:Pharyngeal Muscles / Q000187:drug effects / Q000503:physiopathology; D011183:Postoperative Complications / Q000139:chemically induced* / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology; D012132:Respiratory Muscles / Q000187:drug effects / Q000503:physiopathology; D012133:Respiratory Paralysis / Q000139:chemically induced* / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology; D012680:Sensitivity and Specificity
D003505:Cyclodextrins; D003473:Neuromuscular Nondepolarizing Agents