Residual neuromuscular blockade and postoperative critical respiratory events: literature review.
OBJECTIVE
To investigate and synthesise published literature on the associations between residual neuromuscular blockade and critical respiratory events of postoperative adult patients in the postanaesthesia care unit.


BACKGROUND
Residual neuromuscular blockade continues to be common among patients transferred to the postanaesthesia care unit after general anaesthesia, while negative effects of residual neuromuscular blockade on respiratory function have been demonstrated in laboratory volunteers.


METHODS
Literature review.


METHODS
Using key terms, a search was conducted in Cumulative Index for Nursing and Allied Health Literature, PubMed, Web of Science, Cochrane Database and EMBASE (January 1990-May 2013) for clinical trials or observational studies on the associations between residual neuromuscular blockade and critical respiratory events, published in English-language journals.


RESULTS
Nine articles met the inclusion criteria. Residual neuromuscular blockade definition threshold differed between studies. Among critical respiratory events, only hypoxaemia was investigated in all included studies. Residual neuromuscular blockade was significantly associated with increased incidence of hypoxaemia during postanaesthesia care unit stay in most studies, while associations with the rest of the critical respiratory events were inconclusive.


CONCLUSIONS
Although limited, existing research has provided evidence that patients with residual neuromuscular blockade are at high risk of early postoperative hypoxaemia. Further studies are needed to investigate independent associations between residual neuromuscular blockade and critical respiratory events, along with causality of these associations. The clinical importance of residual neuromuscular blockade for groups at high risk of critical respiratory events should also be investigated.


CONCLUSIONS
Healthcare professionals have to be aware of the increased risk of hypoxaemia in patients with residual neuromuscular blockade. Efforts to decrease residual neuromuscular blockade incidence, combined with identification and appropriate evaluation of patients with residual neuromuscular blockade during postanaesthesia care unit stay, are recommended.
Nursing Department, Technological Educational Institute of Western Greece, Patras, Greece.
Panagiotis
P
Kiekkas
Nick
N
Bakalis
Nikolaos
N
Stefanopoulos
Evangelos
E
Konstantinou
Diamanto
D
Aretha
D000762:Anesthesia Recovery Period; D055191:Delayed Emergence from Anesthesia / Q000209:etiology / Q000503:physiopathology*; D006801:Humans; D000860:Hypoxia / Q000209:etiology*; D019148:Neuromuscular Blockade / Q000009:adverse effects*; D011184:Postoperative Period
airway obstruction; airway support; critical respiratory events; hypoxaemia; literature review; postanaesthesia care unit; postoperative patients; residual neuromuscular blockade