Abstract

Postoperative residual neuromuscular block is a serious complication after general anesthesia which endangers the patient safety. The aim of the study is to assess the reversal after neuromuscular blockade without Train Of Four (TOF) monitoring and reversal using quantitative TOF monitoring. Method: This prospective, single centre, observational study includes 60 patients of American society of Anaesthesiologists (ASA) grade 1 and 2 requiring general anaesthesia for elective surgeries of <3 hour duration. The cohort of patients was formed as those who received reversal strategy based on train of four quantitative monitoring (group A) and those who received optimal neostigmine reversal strategy without train of four monitoring (group B). All patients were monitored for total dose and time duration since last dose of vecuronium bromide administered, dose of neostigmine, reversal extubation time, TOF value in recovery room, pulse rate, blood pressure (BP), airway problems, respiration patterns, oxygen saturation, nausea and vomiting during and after 30 minute (min) in the recovery room. Observation, tabulation, statistical analysis done using Chi-Square Test, one way ANOVA test by SPSS version 20 software. Results: The time interval between administration of neostigmine and tracheal extubation of group B was longer (16.10±1.88) min than group A (13.40±2.08) min. The TOF ratio in recovery room in group A was (0.96±0.05) and in group B was (0.91±0.1). Conclusion: The study concluded that anaesthetists should not rely on clinical criteria alone, even when using an intermediate-acting neuromuscular blocking agent. However in absence of neuromuscular monitoring, optimised use of reversal agent can reduce the chances of adverse events.

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