title: Management of neuromuscular blockade in ambulatory patients.
abstract: OBJECTIVE
  The use of neuromuscular blocking agents in ambulatory surgery has been described as a double-edged sword. Muscle relaxants may improve the outcome following endotracheal intubation and could be helpful for the surgeon to some extent. However, these agents might increase the risk of postoperative complications because of residual paralysis. This review should summarize recent developments in neuromuscular blockade, neuromuscular monitoring, and reversal with a special reference to day case surgery.
  
  
  RESULTS
  The use of neuromuscular blocking agents begs a risk of postoperative muscle weakness and has been associated with adverse respiratory events. From the surgical side, there could be an increased request for a more intense neuromuscular block during laparoscopic surgery. Therefore, the use of quantitative neuromuscular monitoring and selective reversal binding agents may gain more importance in the future. For the reversal of a shallow neuromuscular block, cholinesterase inhibitors are still appropriate.
  
  
  CONCLUSIONS
  The management of neuromuscular blocks in day case surgery requests a comprehensive approach that should include an adequate dosing of the muscle relaxant, quantitative objective monitoring, and a sufficient and appropriate reversal.
authors.affiliation: Department of Anesthesia, Maastricht University Medical Center, Maastricht, The Netherlands.
authors.forename: Jan-Uwe
authors.initials: JU
authors.lastname: Schreiber
mesh_terms: D000556:Ambulatory Surgical Procedures / Q000379:methods*; D002800:Cholinesterase Inhibitors / Q000627:therapeutic use; D006801:Humans; D009388:Neostigmine / Q000627:therapeutic use; D019148:Neuromuscular Blockade / Q000379:methods*; D009466:Neuromuscular Blocking Agents / Q000037:antagonists & inhibitors / Q000627:therapeutic use*; D011183:Postoperative Complications / Q000517:prevention & control
chemical_list: D002800:Cholinesterase Inhibitors; D009466:Neuromuscular Blocking Agents; D009388:Neostigmine