| dc.description.abstract | Residual neuromuscular blockade (RNMB) is a major deterrent to use of Neuromuscular blocking
drugs (NMBDs) during general anaesthesia. It is associated with potentially fatal Acute
Respiratory Events (AREs) like upper airway obstruction, aspiration, hypoxia and atelectasis. In
this study, we set out to determine the incidence, associated factors and complications of RNMB
in our setting.
Methodology:
We conducted a multicenter prospective observational study in three Ugandan referral hospitals.
We recruited 485 adult patients (≥18 years) admitted to the Post Anaesthesia Care Unit (PACU)
who had received a Non-Depolarizing Neuromuscular Blocking Drug (ND-NMBD) during
surgery. The primary outcome was the incidence of RNMB in the PACU defined as a train of four
ratio (TOFR) less than 0.9 measured at the adductor pollicis using acceleromyography. Associated
factors and complications of RNMB were also studied.
Results:
Postoperative RNMB was detected in 160 (33%) patients and AREs were noted in 177 (36.5%)
patients. Elderly patients (age >65) and patients who received additional doses of NMBDs
intraoperatively were more likely to have RNMB, OR 2.39 and 6.08 respectively. Use of
neostigmine and surgeries lasting >90 minutes were protective against RNMB, OR 0.43 and 0.18
respectively. We found no correlation between RNMB and obesity or use of long acting NDNMBDs. Independent risk factors of AREs in the PACU were obesity (BMI ≥30) and level of
consciousness on the Aldrete score of less than 2 at admission to PACU. Residual neuromuscular
blockade was not associated with significant increase in AREs and length of stay in the PACU.
Conclusion:
The incidence of postoperative RNMB is high. The risk was higher in the elderly and those who
received additional doses of NMBDs. There is need for routine monitoring of perioperative NeuroMuscular Blockade (NMB) and use of NMBD reversal agents. | en_US |
