Monday, 30 September 2013

Residual paralysis - helpful refresher article

Residual paralysis: a real problem or did we invent a new disease? Canadian journal of Anesthesia  July 2013.
Since Neuromuscular blockade reversal is so topical at Westmead currently, we have included this continuing professional development article from the CJA. This article discusses the physiological effects of residual neuromuscular blockade and estimates the extent of the problem. Surveys show the majority of anaesthetist underestimate the incidence of residual paralysis. The correct interpretation of neuromuscular monitoring and pitfalls to be avoided are discussed. The article points out the ceiling effect of neostigmine, which may occur at or near clinically used doses. Furthermore they recommend at least 4 twitches prior to reversal to obtain a TOF ratio of > 0.9 at 10-15 minutes. This is a good refresher article for the next departmental discussion on Sugammadex.

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