ESAIC Academy

About this Webinar
Residual paralysis affects 20 % - 50% of surgical patients undergoing relaxant anaesthesia and contributes to postoperative pulmonary complications (POPC). The incidence of POPC ranges from 20% in the postanaesthesia care unit to 8% on the postoperative ward. Moreover, 5% are severe complications like pneumonia or aspiration requiring reintubation and prolongation of the hospital stay.

Measures have been proposed to avoid residual neuromuscular blockades including the use of neuromuscular monitoring and administration of reversal agents. These measures alone or in combination have been demonstrated to reduce the incidence of residual neuromuscular blockade, especially when quantitative devices with a readout of the train-of-four ratio (TOFR) are used.
Nevertheless, optimal routines for avoiding residual paralysis are not regularly practised. Anaesthesiologists still do not monitor neuromuscular function, still use inadequate monitoring equipment, and still do not adhere to the recommendation that tracheal extubation is not performed before the TOFR is greater than 0.9. In addition, reversal agents given in doses that are not adjusted to the depth of the residual blockade may not deliver
the required effect.

Acceleromyography, the most frequently used technique, overestimates the level of recovery. This problem can be addressed by normalization, which is seldom applied in clinical practice and may be a deterrent to routine use of acceleromyography.
Efficient use of electromyography, correctly placed, may greatly enhance the ability to guarantee complete recovery from neuromuscular block, to estimate the optimal dose of reversal agents, and to enhance patient throughput in a cost-effective manner.

In this live Webinar we will focus on such strategies to prevent residual paralysis in the OR.
We will present a step-wise approach based on real patient examples for healthcare professionals to exclude the risk of residual paralysis.

Key Points of this Webinar
This webinar will enable anaesthesiologists to recognise that:
- Optimal surgical conditions can only be maintained and guaranteed by quantitative neuromuscular monitoring
- Correct dosing of reversal agents requires prior knowledge of the degree of residual neuromuscular blockade
- Only quantitative but not qualitative monitoring provides accurate information about the most commonly occurring residual neuromuscular block with a TOFR between 0.4 and 1.0
- Quantitative but not qualitative monitoring significantly reduces the number of patients having unidentified residual neuromuscular block after surgery
- Electromyography (EMG) is the most precise neuromuscular monitoring technique currently available

Session information
Case-Based Presentation
Anaesthesia in a morbidly obese ASA 3 female patient scheduled for laparoscopic cholecystectomy
Surgeons struggle with worsening operating conditions, anaesthesiologist estimates neuromuscular function in the hand using a peripheral nerve stimulator and could cannot feel any twitch response. The patient receives three increments of rocuronium perioperatively.