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Atracurium is associated with postoperative residual curarization
C McCaul1, E Tobin, J F Boylan
1Department of Anaesthesia, Intensive Care and Pain Medicine, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland.
British Journal of Anaesthesia
|October 24, 2002
Summary
Postoperative residual curarization (PORC) affects 65% of patients after atracurium use, highlighting a persistent clinical problem. Shorter surgeries increase the risk of PORC, necessitating improved training and quality assurance.
Area of Science:
- Anesthesiology
- Pharmacology
- Critical Care Medicine
Background:
- Residual paralysis post-neuromuscular blocking drugs is a significant clinical issue.
- Atracurium is commonly used, but its impact on residual paralysis requires evaluation.
- Postoperative residual curarization (PORC) is a key concern in anesthesia quality assurance.
Purpose of the Study:
- To quantify the incidence of PORC following atracurium administration.
- To identify factors associated with PORC in patients undergoing general anesthesia.
- To assess the effectiveness of peripheral nerve stimulators in preventing PORC.
Main Methods:
- Mechanomyography was used for quantitative neuromuscular monitoring in 40 patients.
- Train-of-four (TOF) stimulation assessed neuromuscular function.
- PORC was defined as a TOF ratio of ≤0.7 at extubation.
Main Results:
- 65% of patients exhibited PORC at extubation (TOF ratio ≤0.7).
- Shorter surgical duration was the sole predictor of PORC (OR 0.94, P<0.01).
- Peripheral nerve stimulator use did not reduce PORC incidence but prolonged the interval to extubation.
Conclusions:
- PORC remains a prevalent issue despite current anesthetic practices.
- Patients undergoing short procedures are at higher risk for PORC, potentially due to early extubation.
- Enhanced training on neuromuscular blockade antagonism and quality assurance for short procedures is recommended.