Reversing neuromuscular blockade

[deleted875186]

What do other people do with somewhat long cases where you have given a dose of rocuronoum or vecueonium with induction, and haven't redosed, and patient, they now have four strong twitches. Do you give them anything for reversal or just document that they have four strong twitches, sustained tetanus, etc.

If you don't reverse, what is your time limit from last dose of an intermediate acting muscle relaxant.

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[deleted59964]

Your focus on documentation intrigues me

 

[AppTrail]

If pt isn't elderly/frail or has no Usually 3 hours

What do other people do with somewhat long cases where you have given a dose of rocuronoum or vecueonium with induction, and haven't redosed, and patient, they now have four strong twitches. Do you give them anything for reversal or just document that they have four strong twitches, sustained tetanus, etc.

If you don't reverse, what is your time limit from last dose of an intermediate acting muscle relaxant.

Usually 3 hours and I won't reverse. Unless pt is elderly/frail/ASA4/significant liver/Renal disease

 

[AdmiralChz]

Sustained tetanus if you are concerned there is significant residual blockade. It's pretty obvious if there is fade - if there isn't any, I don't see much role for reversal especially if you haven't redosed NMB.

 

[deleted875186]

Sustained tetanus if you are concerned there is significant residual blockade. It's pretty obvious if there is fade - if there isn't any, I don't see much role for reversal especially if you haven't redosed NMB.

So for TOF, four twitchs and you can still have 75% of your receptors blocked. Ideally if it's been several hours since last rocuronoum dose, the drug should be gone. Sustained tetanus suggests less receptors are blocked. I only say document twithes in the case that some respiratory event happens in the PACU and you haven't reversed the patient.

Just curious because the hospital I'm at, everyone gets reversed o matter what due to fear of residual paralysis, even in healthy patients.

 

[Urzuz]

Hmm. Three posts. Only other post is:

For some that has obstructive lung disease, their FRC will be increased. Does this mean that for someone with COPD, all else being equal, they will maintain their sats longer with apnea after preoxygenation than a lung with comparatively normal FRC.

Something stinks. Only medico-legal type questions...

 

[Arch Guillotti]

Closing.