Residual neuromuscular blockade and postoperative critical respiratory events: literature review

Authors

  • Panagiotis Kiekkas MSc, PhD, RN,

    Assistant Professor, Corresponding author
    1. Nursing Department, Technological Educational Institute of Western Greece, Patras, Greece
    • Correspondence: Panagiotis Kiekkas, Assistant Professor, 76 Stratigou Konstantinopoulou Street, Aroi, Patras 263-31, Greece. Telephone: +30 2610 274789.

      E-mail: kiekkpan@otenet.gr

    Search for more papers by this author
  • Nick Bakalis PhD, RN,

    Assistant Professor
    1. Nursing Department, Technological Educational Institute of Western Greece, Patras, Greece
    Search for more papers by this author
  • Nikolaos Stefanopoulos PhD, RN,

    Assistant Professor
    1. Nursing Department, Technological Educational Institute of Western Greece, Patras, Greece
    Search for more papers by this author
  • Evangelos Konstantinou PhD, RN,

    Associate Professor in Nurse Anesthesia
    1. Nursing Department, National and Kapodistrian Athens University, Athens, Greece
    Search for more papers by this author
  • Diamanto Aretha MD, PhD

    Anesthesiology Consultant
    1. Anesthesiology Department, General Hospital of Pyrgos, Pyrgos, Greece
    Search for more papers by this author

Abstract

Aims and objectives

To investigate and synthesise published literature on the associations between residual neuromuscular blockade and critical respiratory events of postoperative adult patients in the postanaesthesia care unit.

Background

Residual neuromuscular blockade continues to be common among patients transferred to the postanaesthesia care unit after general anaesthesia, while negative effects of residual neuromuscular blockade on respiratory function have been demonstrated in laboratory volunteers.

Design

Literature review.

Methods

Using key terms, a search was conducted in Cumulative Index for Nursing and Allied Health Literature, PubMed, Web of Science, Cochrane Database and EMBASE (January 1990–May 2013) for clinical trials or observational studies on the associations between residual neuromuscular blockade and critical respiratory events, published in English-language journals.

Results

Nine articles met the inclusion criteria. Residual neuromuscular blockade definition threshold differed between studies. Among critical respiratory events, only hypoxaemia was investigated in all included studies. Residual neuromuscular blockade was significantly associated with increased incidence of hypoxaemia during postanaesthesia care unit stay in most studies, while associations with the rest of the critical respiratory events were inconclusive.

Conclusions

Although limited, existing research has provided evidence that patients with residual neuromuscular blockade are at high risk of early postoperative hypoxaemia. Further studies are needed to investigate independent associations between residual neuromuscular blockade and critical respiratory events, along with causality of these associations. The clinical importance of residual neuromuscular blockade for groups at high risk of critical respiratory events should also be investigated.

Relevance to clinical practice

Healthcare professionals have to be aware of the increased risk of hypoxaemia in patients with residual neuromuscular blockade. Efforts to decrease residual neuromuscular blockade incidence, combined with identification and appropriate evaluation of patients with residual neuromuscular blockade during postanaesthesia care unit stay, are recommended.

Ancillary