Residual neuromuscular block in elderly patients after surgical procedures under general anaesthesia with rocuronium

Incomplete recovery of neuromuscular function following the administration of medium-acting, non- -depolarising agents is one of the most feared complications in anaesthesia. We assessed the incidence of postoperative residual curarisation (PORC) after general anaesthesia with rocuronium in elderly and young patients, and we evaluated possible complications of postoperative residual curarisation.

This observational study included 415 patients (ASA physical status I-III) who were undergoing different surgical procedures: 184 patients were aged ≥ 65 (range: 65-89) years, and 231 patients were aged 19-57 years. No patients had renal or hepatic disorders. Patients received rocuronium for relaxation. Neuromuscular monitoring was not used intraoperatively. Neuromuscular function recovery was spontaneous. Patients were transferred to the post-anaesthesia care unit (PACU) after anaesthesia. During the first ten minutes in the post-anaesthesia care unit, the presence of postoperative residual curarisation was assessed by acceleromyography and train-of-four (TOF) stimulation. Patient well-being was monitored continuously. During hospitalisation, patient medical documentation was assessed for postoperative residual curarisation-related complications.

TOF ratios were < 0.7 in 31% of all patients, whereas the block was clinically completely recovered in all patients. Postoperative residual curarisation was more frequent in elderly (44%) than younger patients (20%) (P < 0.05). Only 73 patients (21 elderly, 52 younger patients) had TOF ratios ≥ 0.9. Hypoxia was more frequent in elderly patients in the PACU: 17.9% vs. 8.2% (P < 0.05). Postoperative residual curarisation-related pneumonia was observed in one elderly patient.

Residual paralysis remains a major problem in geriatric clinical anaesthesia. Neuromuscular function monitoring is obligatory, and pharmacological reversal of relaxation should be advised in geriatric patients after using relaxants for general anaesthesia.