Residual Paralysis: Does it Influence Outcome After Ambulatory Surgery?

Hassan Farhan, Ingrid Moreno-Duarte, Duncan McLean, Matthias Eikermann

Research output: Contribution to journalArticlepeer-review

21 Scopus citations


Neuromuscular blocking agents are used to facilitate tracheal intubation in patients undergoing ambulatory surgery. The use of high-dose neuromuscular blocking agents to achieve muscle paralysis throughout the case carries an increased risk of residual post-operative neuromuscular blockade, which is associated with increased respiratory morbidity. Visually monitoring the train-of-four (TOF) fade is not sensitive enough to detect a TOF fade between 0.4 and 0.9. A ratio <0.9 indicates inadequate recovery. Quantitative neuromuscular transmission monitoring (e.g., acceleromyography) should be used to exclude residual neuromuscular blockade at the end of the case. Residual neuromuscular blockade needs to be reversed with neostigmine, but it’s use must be guided by TOF monitoring results since deep block cannot be reversed, and neostigmine administration after complete recovery of the TOF-ratio can induce muscle weakness. The development and use of new selectively binding reversal agents (sugammadex and calabadion) warrants reevaluation of this area of clinical practice.

Original languageEnglish (US)
Pages (from-to)290-302
Number of pages13
JournalCurrent Anesthesiology Reports
Issue number4
StatePublished - Dec 2014
Externally publishedYes


  • Ambulatory surgery
  • Calabadion
  • NMBA
  • Neostigmine
  • PORC
  • Residual paralysis
  • Respiratory complications
  • Sugammadex

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine


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