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Anesthesiology Research and Practice
Volume 2015 (2015), Article ID 410248, 4 pages
Research Article

Postoperative Residual Neuromuscular Paralysis at an Australian Tertiary Children’s Hospital

1School of Medicine and Pharmacology, University of Western Australia, Perth 6009, WA, Australia
2Department of Anaesthesia and Pain Medicine, Royal Perth Hospital, Perth 6000, WA, Australia
3Department of Anaesthesia and Pain Management, Princess Margaret Hospital for Children, Perth 6008, Australia

Received 25 February 2015; Revised 16 April 2015; Accepted 23 April 2015

Academic Editor: Ferenc Petak

Copyright © 2015 Thomas Ledowski et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Purpose. Residual neuromuscular blockade (RNMB) is known to be a significant but frequently overlooked complication after the use of neuromuscular blocking agents (NMBA). Aim of this prospective audit was to investigate the incidence and severity of RNMB at our Australian tertiary pediatric center. Methods. All children receiving NMBA during anesthesia were included over a 5-week period at the end of 2011 (Mondays to Fridays; 8 a.m.–6 p.m.). At the end of surgery, directly prior to tracheal extubation, the train-of-four (TOF) ratio was assessed quantitatively. Data related to patient postoperative outcome was collected in the postoperative acute care unit. Results. Data of 64 patients were analyzed. Neostigmine was given in 34 cases and sugammadex in 1 patient. The incidence of RNMB was 28.1% overall (without reversal: 19.4%; after neostigmine: 37.5%; n.s.). Severe RNMB (TOF ratio < 0.7) was found in 6.5% after both no reversal and neostigmine, respectively. Complications in the postoperative acute care unit were infrequent, with no differences between reversal and no reversal groups. Conclusions. In this audit, RNMB was frequently observed, particularly in cases where patients were reversed with neostigmine. These findings underline the well-known problems associated with the use of NMBA that are not fully reversed.