Postoperative Residual Neuromuscular Blockade Is Associated with Impaired Clinical Recovery

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BACKGROUND:In this investigation, we sought to determine the association between objective evidence of residual neuromuscular blockade (train-of-four [TOF] ratio <0.9) and the type, incidence, and severity of subjective symptoms of muscle weakness in the postanesthesia care unit (PACU).METHODS:TOF ratios of 149 patients were quantified with acceleromyography on arrival to the PACU. Patients were stratified into 2 cohorts: a TOF <0.9 group (n = 48) or a TOF ≥0.9 (control) group (n = 101). A standardized examination determined the presence or absence of 16 symptoms and 11 signs of muscle weakness on arrival to the PACU and 20, 40, and 60 minutes after admission.RESULTS:The incidence of symptoms of muscle weakness was significantly higher in the TOF <0.9 group at all times (P < 0.001), as was the median (range) number of symptoms from PACU arrival (7 [3–6] TOF <0.9 group vs 2 [0–11] control group; difference 5, 99% confidence interval of the difference 4–6) until 60 minutes after admission (2 [0–12] TOF <0.9 group vs 0 [0–11] control group; difference 2, 99% confidence interval of the difference 1–2) (all P < 0.0001).CONCLUSION:The incidence and severity of symptoms of muscle weakness were increased in the PACU in patients with a TOF <0.9.

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