Abstract

Residual neuromuscular blockade (RNMB) presents a significant patient safety issue for anesthesia providers. Adverse events associated with RNMB include respiratory failure, aspiration, re-intubation, longer PACU stays, and even death. Subjective or clinical tests of NMB, including TOF, do not adequately assess neuromuscular recovery. Quantitative or objective neuromuscular monitoring is the only way to definitively assess adequate neuromuscular recovery and has been shown to decrease the incidence of RNMB and postoperative complications. Quantitative monitors may use electromyography, acceleromyography, mechanomyography, or kinemyography to monitor neuromuscular function. These monitors calculate a train of four ratio, which is a comparison of the strength of the fourth twitch on TOF stimulation to that of the first twitch. Objective neuromuscular monitoring devices provide a real time TOFR value in numerical form. Adequate recovery from NMB is achieved with a TOFR ≥ 0.9. Patients may still demonstrate significant neuromuscular weakness despite having 4 of 4 twitches on TOF and sustained tetanus, and at a TOFR > 0.4, experienced clinicians are unable to detect fade by tactile or visual means. Subjective clinical tests of neuromuscular recovery, such as sustained head lift or tidal volume, are not indicative or predictive of adequate recovery as these tests can be performed by patients who have a significant amount of lingering NMB. The only reliable indicator of full neuromuscular recovery is quantitative measurement of TOFR ≥ 0.9.

Author Details

Ryan Hunt, BSN and Lauren Barnes, DNP, CRNA

Sigma Membership

Unknown

Lead Author Affiliation

Samford University, Birmingham, Alabama, USA

Type

DNP Capstone Project

Format Type

Text-based Document

Study Design/Type

Case Study/Series

Research Approach

Translational Research/Evidence-based Practice

Keywords:

Residual Neuromuscular Blockade, Neuromuscular Monitoring, Objective Neuromuscular Monitoring

Advisor

Barnes, Lauren

Second Advisor

Cahoon, Terri

Degree

Doctoral-Other

Degree Grantor

Samford University

Degree Year

2023

Rights Holder

All rights reserved by the author(s) and/or publisher(s) listed in this item record unless relinquished in whole or part by a rights notation or a Creative Commons License present in this item record.

All permission requests should be directed accordingly and not to the Sigma Repository.

All submitting authors or publishers have affirmed that when using material in their work where they do not own copyright, they have obtained permission of the copyright holder prior to submission and the rights holder has been acknowledged as necessary.

Review Type

None: Degree-based Submission

Acquisition

Self-submission

Date of Issue

2023-02-07

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