Incidence of Postoperative Neuromuscular Blockade in Post-Anesthesia Care Unit at Parkland Hospital: Does Size Matter?

University of Texas Southwestern Medical Center100 enrolled

Overview

This prospective, observational study will assess 100 subjects in the post-anesthesia care unit (PACU) at Parkland Hospital. Upon arrival to the PACU, patients' train-of-four (TOF) ratio will be calculated using the StimPod NMS450 accelerometer to determine the presence of any residual paralysis. Any patient with a TOF ratio \< 0.9 will be reassessed every 10 minutes until the ratio is ≥0.90. The time it takes to reach a TOF ratio ≥0.9 will be recorded. Subjects will be classified according to BMI categories: lean as \<30 kg/m2, obese as 30≤BMI≤39.9 kg/m2, and morbidly obese as BMI ≥40 kg/m2. This data will serve as a baseline to assess the incidence of residual NMB that currently occurs in our PACU so that we may use this pilot data to design future studies that aim to reduce the incidence of residual NMB.

Upon arrival to the PACU, patients enrolled in the study will be evaluated for residual paralysis with train-of-four (TOF) stimulation using the StimPod NMS450 accelerometer set to 30 mA. Any patients who have residual paralysis will be assessed Q10 minutes until the TOF ratio is ≥0.9. The time to achieve a TOF ratio ≥0.9 will be recorded. Any adverse events (e.g., hypoxia, reintubation, aspiration) that arise during the patient's PACU stay will be documented.

Study Type

OBSERVATIONAL

Enrollment

100

Conditions

Residual Neuromuscular Blockade

Eligibility

Sex: ALLMin age: 18 YearsMax age: 80 Years

Medical Language ↔ Plain English

Inclusion Criteria: * 18-80 years old * Undergoing non-emergent surgery with general endotracheal anesthesia * ASA physical status classification 1 to 4 * Willing and able to consent in English or Spanish * No personal history of neuromuscular disease Exclusion Criteria: * Age less than 18 or older than 80 * Patient does not speak English or Spanish * Planned postoperative intubation or ICU admission * Allergy to sugammadex, neostigmine, glycopyrrolate, or rocuronium * Family or personal history of malignant hyperthermia * Patient refusal * Monitored anesthesia care (MAC) or regional anesthesia planned * Pregnant or nursing women * "Stat" (emergent) cases * Estimated creatinine clearance \<30 mL/min * Pre-existing muscle weakness of any etiology

Outcomes

Primary Outcomes

Incidence of Residual Neuromuscular Blockade

To establish the current incidence of postoperative residual neuromuscular blockade (NMB), defined as a train-of-four ratio \<0.9, in patients upon arrival to the PACU.

Time frame: 1 day on arrival to PACU

Secondary Outcomes

Comparison of RNMB in Lean, Obese, and Morbidly Obese Patients

To assess the differences in the incidence of postoperative residual neuromuscular blockade (NMB) among PACU patients categorized based on body mass index (BMI) (lean, obese, and morbidly obese).