title: Survey of postoperative residual curarization, acute respiratory events and approach of anesthesiologists.
abstract: OBJECTIVE
  residual paralysis following the use of neuromuscular blocking drugs (NMBDs) without neuromuscular monitoring remains a clinical problem, even when NMBDs are used. This study surveys postoperative residual curarization and critical respiratory events in the recovery room, as well as the clinical approach to PORC of anesthesiologists in our institution.
  
  
  METHODS
  This observational study included 415 patients who received general anesthesia with intermediate-acting NMBDs. Anesthesia was maintained by non-participating anesthesiologists who were blinded to the study. Neuromuscular monitoring was performed upon arrival in the recovery room. A CRE was defined as requiring airway support, peripheral oxygen saturation <90% and 90-93% despite receiving 3 L/min nasal O2, respiratory rate > 20 breaths/min, accessory muscle usage, difficulty with swallowing or speaking, and requiring reintubation. The clinical approach of our anesthesiologists toward reversal agents was examined using an 8-question mini-survey shortly after the study.
  
  
  RESULTS
  The incidence of PORC was 43% (n = 179) for TOFR < 0.9, and 15% (n = 61) for TOFR < 0.7. The incidence of TOFR < 0.9 was significantly higher in women, in those with ASA physical status 3, and with anesthesia of short duration (p < 0.05). In addition, 66% (n = 272) of the 415 patients arriving at the recovery room had received neostigmine. A TOFR < 0.9 was found in 46% (n = 126) of the patients receiving neostigmine.
  
  
  CONCLUSIONS
  When routine objective neuromuscular monitoring is not available, PORC remains a clinical problem despite the use of NMBDs. The timing and optimal antagonism of the neuromuscular blockade, and routine objective neuromuscular monitoring is recommended to enhance patient safety.
authors.affiliation: Department of Anesthesiology and Reanimation, Sami Ulus Children's Hospital, Ankara, Turkey.
authors.forename: Ismail
authors.initials: I
authors.lastname: Aytac
authors.affiliation: Department of Anesthesiology and Reanimation, Numune Education and Research Hospital, Ankara, Turkey. Electronic address: aysunposta@yahoo.com.
authors.forename: Aysun
authors.initials: A
authors.lastname: Postaci
authors.affiliation: Department of Anesthesiology and Reanimation, Numune Education and Research Hospital, Ankara, Turkey.
authors.forename: Betul
authors.initials: B
authors.lastname: Aytac
authors.affiliation: Department of Anesthesiology and Reanimation, Numune Education and Research Hospital, Ankara, Turkey.
authors.forename: Ozlem
authors.initials: O
authors.lastname: Sacan
authors.affiliation: Department of Anesthesiology and Reanimation, Numune Education and Research Hospital, Ankara, Turkey.
authors.forename: Gulcin Hilal
authors.initials: GH
authors.lastname: Alay
authors.affiliation: Department of Biostatistics, Faculty of Health Sciences, Gazi University, Ankara, Turkey.
authors.forename: Bulent
authors.initials: B
authors.lastname: Celik
authors.affiliation: Department of Anesthesiology and Reanimation, Ministry of Health Etlik Education and Research Hospital, Ankara, Turkey.
authors.forename: Kadriye
authors.initials: K
authors.lastname: Kahveci
authors.affiliation: Department of Anesthesiology and Reanimation, Numune Education and Research Hospital, Ankara, Turkey.
authors.forename: Bayazit
authors.initials: B
authors.lastname: Dikmen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000768:Anesthesia, General / Q000379:methods; D000072080:Anesthesiologists / Q000706:statistics & numerical data; D055191:Delayed Emergence from Anesthesia / Q000453:epidemiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009388:Neostigmine / Q000008:administration & dosage*; D019148:Neuromuscular Blockade / Q000379:methods*; D009466:Neuromuscular Blocking Agents / Q000008:administration & dosage*; D061886:Neuromuscular Monitoring / Q000379:methods; D011446:Prospective Studies; D012737:Sex Factors; D011795:Surveys and Questionnaires; D013997:Time Factors; D055815:Young Adult
chemical_list: D009466:Neuromuscular Blocking Agents; D009388:Neostigmine
keywords: Acute respiratory events; Bloqueio neuromuscular; Complications; Complicações; Curarização residual; Eventos respiratórias agudos; Monitoração; Monitoring; Neuromuscular block; Postoperative; Pós-operatório; Residual curarization