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Postoperative residual curarization

Postoperative residual curarization
Electromyographic recording at adductor pollicis muscle and stimulation of the ulnar nerve.jpg
Electromyographic monitoring at the adductor policies muscle.
Neuromuscular monitoring demonstrating the recovery of the train of four (TOF) ratio using electromyography.jpg

Postoperative residual curarization (PORC) or residual neuromuscular blockade (RNMB) is a residual paresis after emergence from general anesthesia that may occur with the use of neuromuscular-blocking drugs.[1][2] Today residual neuromuscular blockade is defined as a train of four ratio[3] of less than 0.9 when measuring the response to ulnar nerve stimulation at the adductor pollicis muscle using mechanomyography or electromyography.[4] A meta-analysis reported that the incidence of residual neuromuscular paralysis was 41% in patients receiving intermediate neuromuscular blocking agents during anaesthesia.[5] It is possible that > 100,000 patients annually in the USA alone, are at risk of adverse events associated with undetected residual neuromuscular blockade.[6] Neuromuscular function monitoring and the use of the appropriate dosage of sugammadex to reverse blockade produced by rocuronium can reduce the incidence of postoperative residual curarization.[7] In this study, with usual care group receiving reversal with neostigmine resulted in a residual blockade rate of 43%.


  1. ^ Naguib M, Kopman AF, Ensor JE (2007). "Neuromuscular monitoring and postoperative residual curarisation: a meta-analysis". Br J Anaesth. 98 (3): 302–316. doi:10.1093/bja/ael386. PMID 17307778.
  2. ^ Baillard C (2005). "Postoperative residual neuromuscular block: a survey of management". Br J Anaesth. 95 (5): 622–626. doi:10.1093/bja/aei240. PMID 16183681.
  3. ^ Ortega, Rafael; Brull, Sorin J.; Prielipp, Richard; Gutierrez, Alexander; De La Cruz, Rossemary; Conley, Christopher M. (2018-01-25). "Monitoring Neuromuscular Function". New England Journal of Medicine. 378 (4): e6. doi:10.1056/nejmvcm1603741. ISSN 0028-4793. PMID 29365307.
  4. ^ Naguib, M.; Brull, S. J.; Johnson, K. B. (2017). "Conceptual and technical insights into the basis of neuromuscular monitoring". Anaesthesia. 72 (S1): 16–37. doi:10.1111/anae.13738. ISSN 1365-2044. PMID 28044330.
  5. ^ Naguib, M.; Kopman, A.F.; Ensor, J.E. (2007). "Neuromuscular monitoring and postoperative residual curarisation: a meta-analysis". British Journal of Anaesthesia. 98 (3): 302–316. doi:10.1093/bja/ael386. ISSN 0007-0912.
  6. ^ Brull, Sorin J.; Naguib, Mohamed; Miller, Ronald D. (2008). "Residual Neuromuscular Block: Rediscovering the Obvious". Anesthesia & Analgesia. 107 (1): 11–14. doi:10.1213/ane.0b013e3181753266. ISSN 0003-2999.
  7. ^ Brueckmann, B.; Sasaki, N.; Grobara, P.; Li, M.K.; Woo, T.; de Bie, J.; Maktabi, M.; Lee, J.; Kwo, J. (November 2015). "Effects of sugammadex on incidence of postoperative residual neuromuscular blockade: a randomized, controlled study". British Journal of Anaesthesia. 115 (5): 743–751. doi:10.1093/bja/aev104. ISSN 0007-0912.

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