Newer Neuromuscular Blocking Drugs - Whether to Reverse or Not?

An editorial by Churchill-Davidson in 1965 expressed the clinical problem succinctly: ‘To reverse, or not to reverse’: that is the question! Since the introduction of d-tubocurarine into clinical anaesthesia this question has received opposing answers’. Now, more than six decades later this issue has yet to be resolved. The introduction of neuromuscular blocking drugs (NMBD) into anaesthetic practice 75 years ago revolutionized anesthetic management and currently more than 400 million people receive these agents annually. Neuromuscular blocking drugs (NMBDs) are widely used to facilitate endotracheal intubation during anaesthesia induction and provide muscle relaxation during surgery. This led to the development of major cardiac surgery, paediatric surgery, and neurosurgery, as well as the specialty of critical care. In the presence of muscle relaxants, anaesthesia could be lightened and postoperative recovery was faster. This allowed patients to protect their airway more rapidly on recovery, thereby preventing pulmonary aspiration of stomach contents. Developments in pharmacological management of neuromuscular management have occurred over the last 60 years, which has improved their safety when being used. Residual neuromuscular block (NMB) in PACU is well recognized phenomenon that may increase postoperative morbidity.