AANA Journal Course-Residual Neuromuscular Blockade: Evidence-Based Recommendations to Improve Patient Outcomes

Neuromuscular blocking drugs are administered to facilitate endotracheal intubation and induce paralysis to allow surgeons access to their anatomical target. Traditionally, qualitative measures; such as tactile observation of fade by a peripheral nerve stimulator, are used to assess the extent of the patient's recovery after receiving the neuromuscular blocking agent. Use of these qualitative measures; however, can contribute to high rates of residual neuromuscular blockade (RNMB), placing patients at risk of serious postoperative adverse events. Such adverse events include the need for tracheal reintubation, impaired oxygen and ventilation, increased risk of aspiration and pneumonia, pharyngeal dysfunction, and delayed discharge from the postanesthesia care unit. This problem of RNMB is exacerbated by the use of traditional drugs to reverse the neuromuscular blockade, such as the acetylcholinesterase inhibitor neostigmine. This course will examine the current limitations of qualitative neuromuscular monitoring, introduce the reader to acceleromyography, and outline the advantages of monitoring neuromuscular blockade during the perioperative period. In addition, this course will review the contemporary neuromuscular antagonists, including the newer neuromuscular antagonist sugammadex.