title: Residual neuromuscular blockade: management and impact on postoperative pulmonary outcome.
abstract: OBJECTIVE
  To revise the current literature on concepts for neuromuscular block management. Moreover, consequences of incomplete neuromuscular recovery on patients' postoperative pulmonary outcome are evaluated as well.
  
  
  RESULTS
  The incidence of residual paralysis may be as high as 70% and even small degrees of residual paralysis may have clinical consequences. Neostigmine should not be given before return of the fourth response of the train-of-four-stimulation and no more than 40-50 μg/kg should be given. Sugammadex acts more rapidly and more predictably than neostigmine. Finally, there is convincing evidence in the literature that incomplete neuromuscular recovery may lead to a poor postoperative pulmonary outcome.
  
  
  CONCLUSIONS
  New evidence has emerged about the pathophysiological implications of incomplete neuromuscular recovery. Not only are the pulmonary muscles functionally impaired, but respiratory control is also affected. Residual paralysis endangers the coordination of the pharyngeal muscles and the integrity of the upper airway. However, neuromuscular monitoring and whenever needed pharmacological reversal prevent residual paralysis.
authors.affiliation: aDepartment of Anesthesia and Critical Care, Université de Lorraine, CHU Nancy, Hôpitaux de Brabois, Nancy, France bDepartment of Anesthesiology and Intensive Care, University of Debrecen, Debrecen, Hungary.
authors.forename: Thomas
authors.initials: T
authors.lastname: Fuchs-Buder
authors.forename: Réka
authors.initials: R
authors.lastname: Nemes
authors.forename: Denis
authors.initials: D
authors.lastname: Schmartz
mesh_terms: D000402:Airway Obstruction / Q000453:epidemiology / Q000209:etiology*; D000762:Anesthesia Recovery Period; D002800:Cholinesterase Inhibitors / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D055191:Delayed Emergence from Anesthesia / Q000150:complications / Q000188:drug therapy* / Q000453:epidemiology / Q000503:physiopathology; D006801:Humans; D015994:Incidence; D009388:Neostigmine / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D019148:Neuromuscular Blockade / Q000009:adverse effects*; D061886:Neuromuscular Monitoring / Q000295:instrumentation; D012119:Respiration / Q000187:drug effects*; D012132:Respiratory Muscles / Q000187:drug effects; D000077122:Sugammadex; D016896:Treatment Outcome; D047408:gamma-Cyclodextrins / Q000009:adverse effects / Q000627:therapeutic use
chemical_list: D002800:Cholinesterase Inhibitors; D047408:gamma-Cyclodextrins; D000077122:Sugammadex; D009388:Neostigmine