This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Web of Science (7) Citing Articles via Google Scholar Google Scholar Articles by Murphy, G. S. Articles by Vender, J. S. Search for Related Content PubMed PubMed Citation Articles by Murphy, G. S. Articles by Vender, J. S. Related Collections Airway Monitoring (Non-cardiac) Pharmacology

---

GENERAL ARTICLES

Residual Paralysis at the Time of Tracheal Extubation

Glenn S. Murphy, MD^*, Joseph W. Szokol, MD^*, Jesse H. Marymont, MD^*, Mark Franklin, MD^*, Michael J. Avram, PhD, and Jeffery S. Vender, MD^*

*Department of Anesthesiology, Evanston Northwestern Healthcare, Northwestern University Feinberg School of Medicine, Evanston, Illinois; and Department of Anesthesiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois

Address correspondence and reprint requests to Glenn S. Murphy, MD, Department of Anesthesiology, Evanston Northwestern Healthcare, 2650 Ridge Ave., Evanston, IL 60201. Address e-mail to dgmurphy{at}core.com.

Respiratory and pharyngeal muscle function are impaired during minimal neuromuscular blockade. Tracheal extubation in the presence of residual paresis may contribute to adverse respiratory events. In this investigation, we assessed the incidence and severity of residual neuromuscular block at the time of tracheal extubation. One-hundred-twenty patients presenting for gynecologic or general surgical procedures were enrolled. Neuromuscular blockade was maintained with rocuronium (visual train-of-four [TOF] count of 2) and all subjects were reversed with neostigmine at a TOF count of 2–4. TOF ratios were quantified using acceleromyography immediately before tracheal extubation, after clinicians had determined that complete neuromuscular recovery had occurred using standard clinical criteria (5-s head lift or hand grip, eye opening on command, acceptable negative inspiratory force or vital capacity breath values) and peripheral nerve stimulation (no evidence of fade with TOF or tetanic stimulation). TOF ratios were measured again on arrival to the postanesthesia care unit. Immediately before tracheal extubation, the mean TOF ratio was 0.67 ± 0.2; among the 120 patients, 70 (58%) had a TOF ratio <0.7 and 105 (88%) had a TOF ratio <0.9. Significantly fewer patients had TOF ratios <0.7 (9 subjects, 8%) and <0.9 (38 subjects, 32%) in the postanesthesia care unit compared with the operating room (P < 0.001). Our results suggest that complete recovery from neuromuscular blockade is rarely present at the time of tracheal extubation.

This article has been cited by other articles:

				T. J. Gilhuly, B. A. MacLeod, G. A. Dumont, A. M. Bouzane, and S. K. W. Schwarz Improved Neuromuscular Blockade Using a Novel Neuromuscular Blockade Advisory System: A Randomized, Controlled, Clinical Trial Anesth. Analg., November 1, 2008; 107(5): 1609 - 1617. [Abstract] [Full Text] [PDF]

				S. J. Brull, M. Naguib, and R. D. Miller Residual Neuromuscular Block: Rediscovering the Obvious Anesth. Analg., July 1, 2008; 107(1): 11 - 14. [Full Text] [PDF]

				G. S. Murphy, J. W. Szokol, J. H. Marymont, S. B. Greenberg, M. J. Avram, and J. S. Vender Residual Neuromuscular Blockade and Critical Respiratory Events in the Postanesthesia Care Unit Anesth. Analg., July 1, 2008; 107(1): 130 - 137. [Abstract] [Full Text] [PDF]

				M. Naguib, A. F. Kopman, and J. E. Ensor Neuromuscular monitoring and postoperative residual curarisation: a meta-analysis Br. J. Anaesth., March 1, 2007; 98(3): 302 - 316. [Abstract] [Full Text] [PDF]