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AMBULATORY ANESTHESIA

Postoperative Residual Paralysis in Outpatients Versus Inpatients

Guy Cammu, MD, PhD^*, Jan De Witte, MD^*, Jan De Veylder, RN^*, Geert Byttebier, MSc, Dirk Vandeput, MD^*, Luc Foubert, MD, PhD^*, Geert Vandenbroucke, MD^*, and Thierry Deloof, MD^*

*Department of Anesthesiology and Critical Care Medicine, OLV Clinic, Aalst, Belgium; and General Biometric Services and Consulting, Ghent, Belgium

Address correspondence and reprint requests to Guy Cammu, MD, PhD, Department of Anesthesiology and CCM, OLV Clinic, Moorselbaan 164, 9300 Aalst, Belgium. Address e-mail to guy.cammu{at}olvz-aalst.be.

Postoperative residual paralysis is an important complication of the use of neuromuscular blocking drugs. In this prospective study, the incidence of residual paralysis detected as a train-of-four response <90% was less frequent in surgical outpatients (38%) than inpatients (47%) (P = 0.001). This might have been the result of the more frequent use of mivacurium for outpatients. Before undertaking tracheal extubation, the anesthesiologists had applied clinical criteria (outpatients, 49%; inpatients, 45%), pharmacological reversal (26%, 25%), neuromuscular transmission monitoring (12%, 11%), or a combination of these. None of these measures seemed to reduce the incidence of residual paralysis except for quantitative train-of-four monitoring. Postoperatively, eight individual clinical tests or a sum of these tests were also unable to predict residual paralysis by train-of-four. Although the incidence of residual paralysis was less frequent in surgical outpatients, predictive criteria were not evident.

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