• Simão Esteves, Mafalda Martins, Filinto Barros, Fernanda Barros, Manuela Canas, Paula Vitor, Manuel Seabra, Maria M Castro, and Isabel Bastardo.
• Department of Anesthesiology, Hospital de Santo António, Porto, Portugal. ao.esteves@netcabo.pt
• Eur J Anaesthesiol. 2013 May 1;30(5):243-9.

ContextResidual neuromuscular blockade still presents despite the use of intermediate duration muscle relaxants and is a risk factor for postoperative morbidity.ObjectiveTo determine the incidence of incomplete postoperative neuromuscular recovery from anaesthesia in a postanaesthesia care unit.DesignMulticentre observational study.SettingPublic Portuguese hospitals.PatientsAdult patients scheduled for elective surgery requiring general anaesthesia with neuromuscular blocking agents.Main Outcome MeasuresAn independent anaesthesiologist measured neuromuscular transmission by the TOF-Watch SX acceleromyograph. Train-of-four ratios at least 0.9 and less than 0.9 were assessed as complete and incomplete neuromuscular recovery following general anaesthesia, respectively.ResultsThe study population consisted of 350 patients [134 men and 216 women, mean (SD) age 54.3 (15.9) years]. Ninety-one patients had a train-of-four ratio less than 0.9 on arrival in the postanaesthesia care unit, an incidence of residual neuromuscular blockade of 26% [95% confidence interval (CI) 21 to 31%]. The most frequent neuromuscular blockers were rocuronium (44.2%) and cisatracurium (32%). A neuromuscular block reversal agent was used in 66.6% of the patients (neostigmine in 97%). The incidence of residual neuromuscular blockade in patients receiving reversal agents was 30% (95% CI 25 to 37%). There were no statistically significant differences in the occurrence of residual blockade relating to the neuromuscular blocker used, although higher percentages were observed for cisatracurium (32.4%) and vecuronium (32%) compared with atracurium (23.6%) and rocuronium (20.8%). Incomplete neuromuscular recovery was significantly more frequent among patients who had received a reversal agent (30.5 vs. 17.1%, P = 0.01). Incomplete neuromuscular recovery was more frequent in patients given propofol than in those exposed to sevoflurane (26.2 vs. 14.3%).ConclusionThe incidence of incomplete neuromuscular recovery of 26% confirms that it is relatively frequent in the postoperative period and calls attention to the dimension of this problem in Portugal.

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