Intraoperative neuromuscular monitoring site and residual paralysis.

Stephan R. Thilen, Bradley E. Hansen, Ramesh Ramaiah, Christopher D. Kent, Miriam Treggiari, Sanjay M. Bhananker

Research output: Contribution to journalArticle

32 Citations (Scopus)

Abstract

Residual paralysis is common after general anesthesia involving administration of neuromuscular blocking drugs (NMBDs). Management of NMBDs and reversal is frequently guided by train-of-four (TOF) monitoring. We hypothesized that monitoring of eye muscles is associated with more frequent residual paralysis than monitoring at the adductor pollicis. This prospective cohort study enrolled 180 patients scheduled for elective surgery with anticipated use of NMBDs. Collected variables included monitoring site, age, gender, weight, body mass index, American Society of Anesthesiologists physical status class, type and duration of surgery, type of NMBDs, last and total dose administered, TOF count at time of reversal, dose of neostigmine, and time interval between last dose of NMBDs to quantitative measurement. Upon postanesthesia care unit admission, we measured TOF ratios by acceleromyography at the adductor pollicis. Residual paralysis was defined as a TOF ratio less than 90%. Multivariable logistic regression was used to account for unbalances between the two groups and to adjust for covariates. 150 patients received NMBDs and were included in the analysis. Patients with intraoperative TOF monitoring of eye muscles had significantly greater incidence of residual paralysis than patients monitored at the adductor pollicis (P < 0.01). Residual paralysis was observed in 51/99 (52%) and 11/51 (22%) of patients, respectively. The crude odds ratio was 3.9 (95% CI: 1.8-8.4), and the adjusted odds ratio was 5.5 (95% CI: 2.1-14.5). Patients having qualitative TOF monitoring of eye muscles had a greater than 5-fold higher risk of postoperative residual paralysis than those monitored at the adductor pollicis.

Original languageEnglish (US)
Pages (from-to)964-972
Number of pages9
JournalAnesthesiology
Volume117
Issue number5
StatePublished - 2012
Externally publishedYes

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Neuromuscular Monitoring
Intraoperative Monitoring
Paralysis
Pharmaceutical Preparations
Muscles
Odds Ratio
Neostigmine
General Anesthesia
Body Mass Index
Cohort Studies
Logistic Models
Prospective Studies
Weights and Measures
Incidence

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

Cite this

Thilen, S. R., Hansen, B. E., Ramaiah, R., Kent, C. D., Treggiari, M., & Bhananker, S. M. (2012). Intraoperative neuromuscular monitoring site and residual paralysis. Anesthesiology, 117(5), 964-972.

Intraoperative neuromuscular monitoring site and residual paralysis. / Thilen, Stephan R.; Hansen, Bradley E.; Ramaiah, Ramesh; Kent, Christopher D.; Treggiari, Miriam; Bhananker, Sanjay M.

In: Anesthesiology, Vol. 117, No. 5, 2012, p. 964-972.

Research output: Contribution to journalArticle

Thilen, SR, Hansen, BE, Ramaiah, R, Kent, CD, Treggiari, M & Bhananker, SM 2012, 'Intraoperative neuromuscular monitoring site and residual paralysis.', Anesthesiology, vol. 117, no. 5, pp. 964-972.
Thilen SR, Hansen BE, Ramaiah R, Kent CD, Treggiari M, Bhananker SM. Intraoperative neuromuscular monitoring site and residual paralysis. Anesthesiology. 2012;117(5):964-972.
Thilen, Stephan R. ; Hansen, Bradley E. ; Ramaiah, Ramesh ; Kent, Christopher D. ; Treggiari, Miriam ; Bhananker, Sanjay M. / Intraoperative neuromuscular monitoring site and residual paralysis. In: Anesthesiology. 2012 ; Vol. 117, No. 5. pp. 964-972.
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