Unrecognised postoperative residual curarisation in developing countries remains a common problem.

Area of Science:

• Anesthesiology
• Critical Care Medicine
• Pharmacology

Background:

• Postoperative residual curarisation (PORC) is a significant risk following anesthesia with non-depolarizing muscle relaxants.
• Reliance on clinical assessment for neuromuscular function overlooks the potential for residual paralysis.
• Quantitative neuromuscular monitoring offers a more objective assessment to mitigate PORC risks.

Purpose of the Study:

• To determine the incidence of PORC in a South African academic hospital's recovery room.
• To evaluate the extent of intraoperative neuromuscular monitoring practices.
• To identify clinical factors associated with an increased risk of PORC.

Main Methods:

• Prospective, cross-sectional study design.
• Recording patient characteristics and intraoperative monitoring data.
• Comparing clinical assessment with quantitative train-of-four ratio (TOFR) measurements for PORC detection.

Main Results:

• PORC incidence was high at 45.5% (TOFR <0.9), while 78% passed clinical assessment.
• Clinical assessment showed low specificity (24%) for detecting residual paralysis.
• Intraoperative neuromuscular monitoring was infrequent (6%); advanced age and female gender correlated with lower TOFR.

Conclusions:

• PORC is significantly underrecognized in clinical practice.
• Low rates of quantitative monitoring and high pass rates on clinical exams highlight this gap.
• Routine quantitative neuromuscular monitoring is recommended to prevent PORC.