[Short acting muscle relaxants: is neuromuscular monitoring still necessary?]

Neuromuscular blocking agents are used to facilitate intubation and to establish muscle paralysis during surgery. However, postoperative residual blocks are a significant complication following the use of neuromuscular blocking agents with an incidence of approximately 30 % at arrival in the post operative care unit. If they are not identified and adequately treated, residual neuromuscular blocks would increase the risk for muscle fatigue, hypoventilation, swallowing disorders, and aspiration. These complications may result in postoperative pulmonary disease. Therefore, monitoring of neuromuscular block is essential not only to detect residual paralysis postoperatively but also to maintain adequate muscle paralysis for surgery. Moreover, the response of individual patients to a particular drug can be variable and needs to be determined for the individual patient in a clinical situation. Sugammadex, the newly developed steroidal muscle relaxant encapsulator, is another important step to optimize treatment with neuromuscular blocking agents but will not replace neuromuscular monitoring. Since qualitative assessment has been shown to be insufficient to validly measure neuromuscular block in the anesthetized patient, it should be monitored quantitatively. Only using this technique and treating residual blocks where required, life threatening complications can certainly be avoided.