title: Postoperative residual neuromuscular blockade is associated with impaired clinical recovery.
abstract: BACKGROUND
  In this investigation, we sought to determine the association between objective evidence of residual neuromuscular blockade (train-of-four [TOF] ratio <0.9) and the type, incidence, and severity of subjective symptoms of muscle weakness in the postanesthesia care unit (PACU).
  
  
  METHODS
  TOF ratios of 149 patients were quantified with acceleromyography on arrival to the PACU. Patients were stratified into 2 cohorts: a TOF <0.9 group (n = 48) or a TOF ≥0.9 (control) group (n = 101). A standardized examination determined the presence or absence of 16 symptoms and 11 signs of muscle weakness on arrival to the PACU and 20, 40, and 60 minutes after admission.
  
  
  RESULTS
  The incidence of symptoms of muscle weakness was significantly higher in the TOF <0.9 group at all times (P < 0.001), as was the median (range) number of symptoms from PACU arrival (7 [3-6] TOF <0.9 group vs 2 [0-11] control group; difference 5, 99% confidence interval of the difference 4-6) until 60 minutes after admission (2 [0-12] TOF <0.9 group vs 0 [0-11] control group; difference 2, 99% confidence interval of the difference 1-2) (all P < 0.0001).
  
  
  CONCLUSIONS
  The incidence and severity of symptoms of muscle weakness were increased in the PACU in patients with a TOF <0.9.
authors: NorthShore University HealthSystem, Evanston Hospital, 2650 Ridge Ave., Evanston, IL 60201, USA. dgmurphy2@yahoo.com
authors: Glenn S
authors: GS
authors: Murphy
authors: Joseph W
authors: JW
authors: Szokol
authors: Michael J
authors: MJ
authors: Avram
authors: Steven B
authors: SB
authors: Greenberg
authors: Torin
authors: T
authors: Shear
authors: Jeffery S
authors: JS
authors: Vender
authors: Jayla
authors: J
authors: Gray
authors: Elizabeth
authors: E
authors: Landry
mesh_terms: D000328:Adult; D000368:Aged; D000762:Anesthesia Recovery Period; D005260:Female; D006801:Humans; D007702:Kinetocardiography / Q000379:methods; D008297:Male; D008875:Middle Aged; D018908:Muscle Weakness / Q000175:diagnosis* / Q000503:physiopathology*; D019148:Neuromuscular Blockade / Q000009:adverse effects*; D061886:Neuromuscular Monitoring / Q000379:methods; D011183:Postoperative Complications / Q000175:diagnosis* / Q000503:physiopathology*