Postoperative residual paralysis in patients aged over 65 years old at the Post-Anesthesia Care Unit
Keywords:
Muscle relaxation, Neuromuscular blocking agents, Recovery room, Aged, Anesthesia
Abstract
Introduction: Few studies have been made on the incidence of residual paralysis from nondepolarizing relaxants in people over 65 years old; however, estimating the number of cases and treatment thereof are both important.
Objective: To study the incidence of residual paralysis with non-depolarizing relaxants in patients over 65 years of age and discuss treatment.
Methodology: Analytical observational study based on a cohort design.
Results: The pre-extubation residual paralysis was estimated at 23.2% and at 9.2% at patient admission to the Recovery Suite. Pharmacological reversal showed 89.4% and 100% success rates with Neostigmine and Sugammadex respectively, with similar times at T4/T1 >0.9.
Conclusions: The incidence of pre-extubation residual paralysis was lower than the figure published worldwide. Pharmacological reversal therapies were typically highly effective.
References
1. Debaene B, Plaud B, Dilly MP, Donati F. Residual paralysis in the PACU after a single intubating dose of nondepolarizing muscle relaxant with an intermediate duration of action. Anesthesiology. 2003;98:1042-8.
2. Claudius C, Garvey LH, Viby-Mogensen J. The undesirable effects of neuromuscular blocking drugs. Anaesthesia. 2009;64 Suppl 1:10-21.
3. Plaud B, Debaene B, Donati F, Marty J. Residual paralysis after emergence from anesthesia. Anesthesiology. 2010;112:1013-22.
4. Donati F. Residual paralysis: a real problem or did we invent a new disease? Can J Anesth. 2013;60:714-29.
5. Fortier LP, McKeen D, Turner K, de Médicis É, Warriner B, Jones PM, et al. The RECITE study: a Canadian prospective multicenter study of the incidence and severity of residual neuromuscular blockade. Anesth Analg. 2015;121:366-72.
6. Murphy GS, Szokol JW, Marymont JH, Franklin M, Avram MJ, Vender JS. Residual paralysis at the time of tracheal extubation. Anesth Analg. 2005;100:1840-5.
7. Naguib M, Kopman AF, Lien CA, Hunter JM, Lopez A, Brull SJ. A survey of current management of neuromuscular block in the United States and Europe. Anesth Analg. 2010;111:110-9.
8. Butterly A, Bittner EA, George E, Sandberg WS, Eikermann M, Schmidt U. Postoperative residual curarization from intermediate-acting neuromuscular blocking agents delays recovery room discharge. Br J Anaesth. 2010;105:304-9.
9. Thilen SR, Hansen BE, Ramaiah R, Kent CD, Treggiari MM, Bhananker SM. Intraoperative neuromuscular monitoring site and residual paralysis. Anesthesiology. 2012;117:964-72.
10. Kumar GV, Nair AP, Murthy HS, Jalaja KR, Ramachandra K, Parameshwara G. Residual neuromuscular blockade affects postoperative pulmonary function. Anesthesiology. 2012;117:1234-44.
11. Murph GS, Brull SJ. Residual neuromuscular block: lessons unlearned. Part I: definitions, incidence, and adverse physiologic effects of residual neuromuscular block. Anesth Analg. 2010;111:120-8.
12. Pietraszewski P, Gaszynski T. Residual neuromuscular block in elderly patients after surgical procedures under general anaesthesia with rocuronium. Anaesthesiol Intensive Ther. 2013;45:77-81.
13. Fuchs-Buder T, Claudius C, Skovgaard T, Eriksson I, Mirakhur K, Viby-Mergensen J. Good clinical research practice in pharmacodynamic studies of neuromuscular blocking agents. II: The Stockholm revision. Acta Anaesthesiol Scand. 2007;51:789-808.
14. Capron F, Alla F, Hottier C, Meistelman C, Fuchs-Buder T. Can acceleromyography detect low levels of residual paralysis? A probability approach to detect a mechanomyographic train-of-four ratio of 0.9. Anesthesiology. 2004;100:1119-24.
15. Fuchs-Buder T, Schreiber JU, Meistelman C. Monitoring neuromuscular block: an update. Anaesthesia. 2009;64 Suppl 1:82-9.
16. Lien CA, Kopman AF. Current recommendations for monitoring depth of neuromuscular blockade. Curr Opin Anesthesiol. 2014;27:616-22.
17. Reyes L, Muñoz L, Orozco D, Arias C, Vergel V, Valencia A. Variabilidad clínica del Vecuronio. Experienciaenunainstituciónen Colombia. Rev Colomb Anestesiol. 2012;40:251-5.
18. Sundman E, Witt H, Olsson R, Ekberg O, Kuylenstierna R, Eriksson LI. The incidence and mechanisms of pharyngeal and upper esophageal dysfunction in partially paralyzed humans: pharyngeal video radiography and simultaneous manometry after atracurium. Anesthesiology. 2000;92:977-84.
19. Baillard C, Cledi C, Catineau J, Salhi F, Gehan G, Cupa M, et al. Postoperative residual neuromuscular block: a survey of management. Br J Anaesth. 2005;95:622-6.
20. González VH, Munar F. Sugammadex en paciente neonatal. Rev Colomb Anestesiol. 2013;41:171-1.
2. Claudius C, Garvey LH, Viby-Mogensen J. The undesirable effects of neuromuscular blocking drugs. Anaesthesia. 2009;64 Suppl 1:10-21.
3. Plaud B, Debaene B, Donati F, Marty J. Residual paralysis after emergence from anesthesia. Anesthesiology. 2010;112:1013-22.
4. Donati F. Residual paralysis: a real problem or did we invent a new disease? Can J Anesth. 2013;60:714-29.
5. Fortier LP, McKeen D, Turner K, de Médicis É, Warriner B, Jones PM, et al. The RECITE study: a Canadian prospective multicenter study of the incidence and severity of residual neuromuscular blockade. Anesth Analg. 2015;121:366-72.
6. Murphy GS, Szokol JW, Marymont JH, Franklin M, Avram MJ, Vender JS. Residual paralysis at the time of tracheal extubation. Anesth Analg. 2005;100:1840-5.
7. Naguib M, Kopman AF, Lien CA, Hunter JM, Lopez A, Brull SJ. A survey of current management of neuromuscular block in the United States and Europe. Anesth Analg. 2010;111:110-9.
8. Butterly A, Bittner EA, George E, Sandberg WS, Eikermann M, Schmidt U. Postoperative residual curarization from intermediate-acting neuromuscular blocking agents delays recovery room discharge. Br J Anaesth. 2010;105:304-9.
9. Thilen SR, Hansen BE, Ramaiah R, Kent CD, Treggiari MM, Bhananker SM. Intraoperative neuromuscular monitoring site and residual paralysis. Anesthesiology. 2012;117:964-72.
10. Kumar GV, Nair AP, Murthy HS, Jalaja KR, Ramachandra K, Parameshwara G. Residual neuromuscular blockade affects postoperative pulmonary function. Anesthesiology. 2012;117:1234-44.
11. Murph GS, Brull SJ. Residual neuromuscular block: lessons unlearned. Part I: definitions, incidence, and adverse physiologic effects of residual neuromuscular block. Anesth Analg. 2010;111:120-8.
12. Pietraszewski P, Gaszynski T. Residual neuromuscular block in elderly patients after surgical procedures under general anaesthesia with rocuronium. Anaesthesiol Intensive Ther. 2013;45:77-81.
13. Fuchs-Buder T, Claudius C, Skovgaard T, Eriksson I, Mirakhur K, Viby-Mergensen J. Good clinical research practice in pharmacodynamic studies of neuromuscular blocking agents. II: The Stockholm revision. Acta Anaesthesiol Scand. 2007;51:789-808.
14. Capron F, Alla F, Hottier C, Meistelman C, Fuchs-Buder T. Can acceleromyography detect low levels of residual paralysis? A probability approach to detect a mechanomyographic train-of-four ratio of 0.9. Anesthesiology. 2004;100:1119-24.
15. Fuchs-Buder T, Schreiber JU, Meistelman C. Monitoring neuromuscular block: an update. Anaesthesia. 2009;64 Suppl 1:82-9.
16. Lien CA, Kopman AF. Current recommendations for monitoring depth of neuromuscular blockade. Curr Opin Anesthesiol. 2014;27:616-22.
17. Reyes L, Muñoz L, Orozco D, Arias C, Vergel V, Valencia A. Variabilidad clínica del Vecuronio. Experienciaenunainstituciónen Colombia. Rev Colomb Anestesiol. 2012;40:251-5.
18. Sundman E, Witt H, Olsson R, Ekberg O, Kuylenstierna R, Eriksson LI. The incidence and mechanisms of pharyngeal and upper esophageal dysfunction in partially paralyzed humans: pharyngeal video radiography and simultaneous manometry after atracurium. Anesthesiology. 2000;92:977-84.
19. Baillard C, Cledi C, Catineau J, Salhi F, Gehan G, Cupa M, et al. Postoperative residual neuromuscular block: a survey of management. Br J Anaesth. 2005;95:622-6.
20. González VH, Munar F. Sugammadex en paciente neonatal. Rev Colomb Anestesiol. 2013;41:171-1.
How to Cite
1.
González-Cárdenas VH, Salazar-Ramírez KJ, Coral-Sánchez GT. Postoperative residual paralysis in patients aged over 65 years old at the Post-Anesthesia Care Unit. Colomb. J. Anesthesiol. [Internet]. 2016 Jul. 1 [cited 2024 Apr. 24];44(3):209-15. Available from: https://www.revcolanest.com.co/index.php/rca/article/view/369
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Published
2016-07-01
How to Cite
1.
González-Cárdenas VH, Salazar-Ramírez KJ, Coral-Sánchez GT. Postoperative residual paralysis in patients aged over 65 years old at the Post-Anesthesia Care Unit. Colomb. J. Anesthesiol. [Internet]. 2016 Jul. 1 [cited 2024 Apr. 24];44(3):209-15. Available from: https://www.revcolanest.com.co/index.php/rca/article/view/369
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