Incidence and risk factors for postoperative residual paralysis

Background: Several studies have shown that neuromuscular block often persists in the recovery room even after the administration of acetyl cholinesterase inhibitors. This postoperative residual neuromuscular paralysis (PORP) may represent serious safety concerns, resulting in respiratory events like muscle weakness, desaturation, pulmonary collapse and acute respiratory failure(1). Methods: We studied 50 patients who underwent general anesthesia and where the neuromuscular blocking agent was used, in order to determine the incidence of PORP in our institution. Results: The incidence of PORP at our hospital was of 14% (seven out of fi fty patients presented train of four < 0.7). The group most frequently associated with PORP was the group that received rocuronium. Surprisingly the use of neuromuscular monitoring both in the operating room and the recovery room remains very limited. Conclusions: Although our anesthesiologists are aware of mechanism of action and secure doses of neuromuscular blocking drug (NMBD), we still found presence of residual paralysis in our hospital. Given that PORP is a potentially preventable patient safety problem, it is important to fi nd ways to reduce its incidence.