In practice guidelines issued by the American Society of Anesthesiologists and published in the January issue of Anesthesiology, recommendations are presented for reducing residual neuromuscular blockade after general anesthesia.

Stephan R. Thilen, M.D., and colleagues from the American Society of Anesthesiologists Task Force on Neuromuscular Blockade, developed practice guidelines for appropriate management of neuromuscular monitoring and antagonisms of neuromuscular blocking agents during and after general anesthesia, specifically focusing on reducing residual neuromuscular blockade.

Six strong recommendations were developed based on evidence of moderate strength. To avoid residual neuromuscular blockade, the authors recommend against clinical assessment alone when neuromuscular blocking drugs are administered due to the insensitivity of the assessment. To avoid residual neuromuscular blockade, quantitative monitoring is recommended over qualitative assessment. Confirmation of a train-of-four ratio greater than or equal to 0.9 before extubation is recommended when using quantitative monitoring. For neuromuscular monitoring, the task force supports the use of the adductor pollicis muscle and recommends against the use of eye muscles. At deep, moderate, and shallow depths of neuromuscular blockage induced by rocuronium or vecuronium, sugammadex is recommended over neostigmine to avoid residual neuromuscular blockade.

“The clinical recommendations for monitoring and reversing this process will help prevent residual neuromuscular blockade so patients benefit from complete recovery, which may decrease the length of stay in the postacute care unit and postoperative lung complications,” Michael W. Champeau, M.D., president of the American Society of Anesthesiologists, said in a statement.

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