Anesthésie et recherche clinique
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Prevalence and Complications of Residual Neuromuscular Blockade in the Post Anesthesia Care Units of Uganda

Emyedu A*, Atumanya P, Okello E, Wabule A, Ssemogerere L, Mukisa J,

Background: Residual neuromuscular blockade is a major deterrent to use of neuromuscular blocking drugs during general anesthesia. It is associated with potentially fatal acute respiratory events like upper airway obstruction, aspiration, hypoxia and atelectasis. In this study, we set out to determine the prevalence and complications of residual neuromuscular blockade in our setting.

Methods: We conducted a multicenter prospective cohort study in three referral hospitals in Uganda from June 2019 to March 2020. We recruited 485 adult patients admitted to the PACU who had received a non-depolarizing neuromuscular blocking drug during surgery. Our primary outcome was the prevalence of residual neuromuscular blockade in the PACU, which was defined as having a train of four ratio <0.9 and the secondary outcomes were associated factors and complications of residual neuromuscular blockade.

Results: Residual neuromuscular blockade was detected in 160 (33%) patients and acute respiratory events were noted in 177 (36.5%) patients. Elderly patients (age ≥ 65) and those who received additional doses of neuromuscular blocking drugs were more likely to have residual neuromuscular blockade, OR 2.39 and 6.08 respectively. Use of neostigmine, ASA III physical status and surgeries lasting >90 minutes were protective against residual neuromuscular blockade, OR 0.43, 0.30 and 0.18 respectively. We found no correlation between residual neuromuscular blockade and obesity or use of long acting neuromuscular blocking drugs. Residual neuromuscular blockade was not associated with statistically significant increased risk of developing acute respiratory events or increased length of stay in the PACU.

Conclusion: The prevalence of residual neuromuscular blockade is high. The risk is higher among elderly patients and those who receive additional doses of neuromuscular blocking drugs Intraoperatively. Use of reversal agents like neostigmine and routine monitoring of perioperative neuromuscular blockade could go a long way towards reducing the risk of residual neuromuscular blockade and its complications.