Purpose of Review Muscle paralysis is a component of many general anesthetics, and monitoring of neuromuscular function is integral to ensuring complete and safe recovery. Recent Findings Recommendations for qualitative neuromuscular blockade have been well-described in the literature for de- cades; however practitioners frequently do not follow recommendations, resulting in patient harm from inadequate reversal of paralysis. Summary This review will focus on evidence-based techniques for patterns of stimulation, sites of monitoring, and accuracy in detecting residual neuromuscular blockade; furthermore, the review will also discuss barriers to implementation of best practices. . . . . . . Keywords Paralysis Neuromuscular blockade Acetylcholinesterase inhibitor Neostigmine Edrophonium Glycopyrrolate . . . Atropine Residual paralysis Postoperative residual curarization Sugammadex Introduction Patterns of Stimulation The classic components of a general anesthetic include Qualitative or subjective monitoring of neuromuscular func- hypnosis, analgesia, and immobility. For nearly a century, tion requires stimulation of a motor nerve, with observation of immobility was achieved via the relaxant properties of the innervated muscle. Patterns of stimulation beyond a single inhaled agents. The agents, however, frequently resulted stimulus (or twitch) reveal more detailed information about in hemodynamic depression. Following the introduction the degree of paralysis, and other modes of
Current Anesthesiology Reports – Springer Journals
Published: Apr 16, 2018
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