Bijkerk Veerle, Krijtenburg Piet, Verweijen Tessa, Bruhn Jörgen, Scheffer Gert Jan, Keijzer Christiaan, Warlé Michiel C
Department of Anaesthesiology, Radboud University Medical Centre, Nijmegen, The Netherlands; Department of Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands.
Department of Anaesthesiology, Radboud University Medical Centre, Nijmegen, The Netherlands.
Br J Anaesth. 2025 Feb;134(2):350-357. doi: 10.1016/j.bja.2024.07.043. Epub 2024 Oct 23.
Concerns regarding residual neuromuscular block (RNMB) have persisted since the introduction of neuromuscular blocking agents, with reported incidences in the 21st century up to 50%. Advances in neuromuscular transmission (NMT) monitoring and the introduction of sugammadex have addressed this issue, but the impact of these developments remains unclear.
This prospective observational study evaluated RNMB in 500 surgical patients in a large Dutch teaching hospital with readily available quantitative NMT monitoring and reversal agents. The anaesthetic technique and intraoperative NMT monitoring were independently chosen by the attending anaesthesiologist. Acceleromyography was performed upon arrival in the PACU for patients who received nondepolarising neuromuscular blocking agents. RNMB was defined as a train-of-four ratio (TOFR) <0.9. A systematic review was conducted to analyse trends in RNMB in contemporary practice.
Out of 500 patients, 11 (2.2%) had a TOFR <0.9. Intraoperative NMT monitoring was performed in 77.6% of patients, and sugammadex was administered to 38% of patients. No patient received neostigmine. The only difference was an automatically recorded TOFR ≥0.9 at the end of surgery in 61.1% in the non-RNMB group compared with 18.2% in the RNMB group (P=0.009). Our systematic review identified incidences ranging from 3.5% to 53.3% since 2000, with a decreasing trend in Europe and North America.
The incidence of residual neuromuscular block in the PACU was 2.2%. This suggests significant improvement in the prevention of residual neuromuscular block and stresses the importance of rigorous neuromuscular transmission monitoring and adequate use of reversal agents.
自神经肌肉阻滞剂问世以来，对残余神经肌肉阻滞（RNMB）的担忧一直存在，据报道在21世纪其发生率高达50%。神经肌肉传递（NMT）监测技术的进步以及舒更葡糖的引入已解决了这一问题，但这些进展的影响仍不明确。
这项前瞻性观察性研究在一家大型荷兰教学医院对500例手术患者的RNMB进行了评估，该医院具备现成的定量NMT监测设备和逆转剂。麻醉技术和术中NMT监测由主治麻醉医生独立选择。对接受非去极化神经肌肉阻滞剂的患者，在到达麻醉后监护病房（PACU）时进行加速度肌电图检查。RNMB定义为四个成串刺激比值（TOFR）<0.9。进行了一项系统评价以分析当代实践中RNMB的趋势。
500例患者中，11例（2.2%）的TOFR<0.9。77.6%的患者进行了术中NMT监测，38%的患者使用了舒更葡糖。没有患者接受新斯的明。唯一的差异是，非RNMB组61.1%的患者在手术结束时自动记录的TOFR≥0.9，而RNMB组为18.2%（P=0.009）。我们的系统评价确定了自2000年以来发生率在3.5%至53.3%之间，欧洲和北美的发生率呈下降趋势。
麻醉后监护病房中残余神经肌肉阻滞的发生率为2.2%。这表明在预防残余神经肌肉阻滞方面有显著改善，并强调了严格的神经肌肉传递监测和充分使用逆转剂的重要性。
