The occurrence of residual curarisation in postoperative patients at an academic hospital
Date
2016
Authors
Hassim, Sakeena
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Abstract
Postoperative residual curarisation (PORC) resulting from the use of non
depolarising muscle relaxants continues to be a significant problem. It is associated
with an increase in morbidity and may delay discharge from the recovery room,
increasing financial costs. An objective measurement of neuromuscular functioning
using an accelerometer is recommended to ensure patient safety. The aim of this
study was to describe the occurrence of PORC in the recovery room in patients who
have received intermediate acting NDMRs intraoperatively at CHBAH.
This was a prospective, contextual and descriptive study. The study sample included
ASA 1 to 3 adult patients who had received an intermediate acting NDMR during
elective surgery and had given pre operative consent to participate in the study.
Neuromuscular function was monitored using acceleromyography. A TOF ratio < 0.9
was defined as having PORC. Data collection took place during December 2014 to
February 2015. Data was analysed using descriptive and inferential statistics.
The study sample consisted of 55 patients. Twenty five patients had a TOF ratio <
0.9 on arrival in the recovery room. The occurrence of PORC was therefore 45.46%.
Intraoperative neuromuscular monitoring was documented to have been done in 3
(5.45%) of the patients. The most frequently used NDMRs were rocuronium 31
(56.36%) and cisatracurium 9 (16.36%). There was no statistically significant
differences in the occurrence of PORC relating to the NDMR used (p=0.72) but
higher percentages were observed with cisatracurium 5 (55.56%). An
anticholinesterase as reversal agent was used in 48 (87.27%) of the patients. PORC
was significantly more frequent in patients who did not receive an anticholinesterase
(85.71 vs. 39.58%, p=0.03). Three patients presented with a temperature < 35 °C.
Incomplete neuromuscular recovery was more frequent in patients with a
temperature < 35 °C, 2 (66.67%) compared to the patients with a temperature ≥ 35
°C 23 (44.23%)
PORC remains a clinical problem in the recovery room. To ensure patient safety
objective neuromuscular monitoring needs to be performed.
Description
A research report submitted to the Faculty of Health Sciences, University of
the Witwatersrand, in partial fulfilment of the requirements for the degree
of
Master of Medicine in Anaesthesiology,
Johannesburg, 2016