Current Status of Neuromuscular Reversal and Monitoring: Challenges and Opportunities.

摘要: Postoperative residual neuromuscular block has been recognized as a potential problem for decades, and it remains so today. Traditional pharmacologic antagonists (anticholinesterases) are ineffective in reversing profound deep levels of block; at the opposite end recovery curve close to full recovery, anticholinesterases may induce paradoxical muscle weakness. The new selective relaxant-binding agent sugammadex can reverse any depth from aminosteroid (but not benzylisoquinolinium) relaxants; however, effective dose be administered should chosen based on objective monitoring block.To guide appropriate perioperative management, function assessment with peripheral nerve stimulator is mandatory. Although many settings, subjective (visual tactile) evaluation responses used, such had limited success preventing occurrence paralysis. Clinical evaluations return strength (head lift grip strength) or respiratory parameters (tidal volume vital capacity) equally insensitive detecting Objective measurement (a train-of-four ratio greater than 0.90) only method determine timing tracheal extubation ensure normal patient safety.