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Neuromuscular monitoring and postoperative residual curarisation: a meta-analysis
1 Department of Anesthesiology and Pain Medicine
2 Department of Biostatistics, The University of Texas M. D. Anderson Cancer Center, Houston, TX, USA
3 New York Medical College, Department of Anesthesiology, Saint Vincent's Hospital Manhattan, New York, NY, USA
* Corresponding author: Department of Anesthesiology and Pain Medicine, Unit 409, The University of Texas M. D. Anderson Cancer Center, 1400 Holcombe Boulevard, Houston, TX 77030, USA. E-mail: naguib{at}mdanderson.org
We conducted a meta-analysis to examine the effect of intraoperative monitoring of neuromuscular function on the incidence of postoperative residual curarisation (PORC). PORC has been considered present when a patient has a train-of-four (TOF) ratio of < 0.7 or < 0.9. We analysed data from 24 trials (3375 patients) that were published between 1979 and 2005. We excluded data on mivacurium from this meta-analysis because only three studies had examined the incidence of PORC associated with its use. Long- and intermediate-acting neuromuscular blocking drugs had been given to 662 and 2713 patients, respectively. Neuromuscular function was monitored in 823 patients (24.4%). A simple peripheral nerve stimulator was used in 543 patients, and an objective monitor was used in 280. The incidence of PORC was found to be significantly lower after the use of intermediate neuromuscular blocking drugs. We could not demonstrate that the use of an intraoperative neuromuscular function monitor decreased the incidence of PORC.
Keywords: complications, postoperative; meta-analysis, postoperative residual curarisation; monitoring, neuromuscular function; neuromuscular block
Declaration of interest. Drs Naguib and Kopman have worked as consultants on an ad hoc basis with Organon Pharmaceuticals (Roseland, NJ, USA) and Avera Pharmaceuticals (San Diego, CA, USA). They are currently involved with multicentre phase IIIa studies of sugammadex.
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