BACKGROUND:Incomplete recovery of neuromuscular function following the administration of medium-acting, non- -depolarising agents is one of the most feared complications in anaesthesia. We assessed the incidence of postoperative residual curarisation (PORC) after general anaesthesia with rocuronium in elderly and young patients, and we evaluated possible complications of postoperative residual curarisation.METHODS:This observational study included 415 patients (ASA physical status I-III) who were undergoing different surgical procedures: 184 patients were aged ≥ 65 (range: 65-89) years, and 231 patients were aged 19-57 years. No patients had renal or hepatic disorders. Patients received rocuronium for relaxation. Neuromuscular monitoring was not used intraoperatively. Neuromuscular function recovery was spontaneous. Patients were transferred to the post-anaesthesia care unit (PACU) after anaesthesia. During the first ten minutes in the post-anaesthesia care unit, the presence of postoperative residual curarisation was assessed by acceleromyography and train-of-four (TOF) stimulation. Patient well-being was monitored continuously. During hospitalisation, patient medical documentation was assessed for postoperative residual curarisation-related complications.RESULTS:TOF ratios were < 0.7 in 31% of all patients, whereas the block was clinically completely recovered in all patients. Postoperative residual curarisation was more frequent in elderly (44%) than younger patients (20%) (P < 0.05). Only 73 patients (21 elderly, 52 younger patients) had TOF ratios ≥ 0.9. Hypoxia was more frequent in elderly patients in the PACU: 17.9% vs. 8.2% (P < 0.05). Postoperative residual curarisation-related pneumonia was observed in one elderly patient.
CONCLUSION:Residual paralysis remains a major problem in geriatric clinical anaesthesia. Neuromuscular function monitoring is obligatory, and pharmacological reversal of relaxation should be advised in geriatric patients after using relaxants for general anaesthesia.
This study was designed to compare the variability of the onset and offset of the effect of two neuromuscular blocking drugs with different elimination pathways in adult and elderly patients during total intravenous anesthesia (TIVA). After Ethics Committee approval and patients' informed consent, the drugs were compared in 40 adult and 40 elderly patients scheduled for elective surgery under TIVA with tracheal intubation who were randomized to receive a single bolus dose of 0.15 mg/kg cisatracurium or 0.9 mg/kg rocuronium. The time of onset of maximum depression, duration of action, and recovery index time were measured and recorded for each patient and variability is reported as means ± standard deviation. Time of onset was significantly shorter for rocuronium than cisatracurium for the adult and elderly groups (P = 0.000), but the variability of cisatracurium was significantly greater compared with rocuronium for the same age groups (93.25 vs 37.01 s in the adult group and 64.56 vs 33.75 s in the elderly group; P = 0.000). The duration of the effect in the elderly group receiving rocuronium was significantly longer than in the elderly group receiving cisatracurium, and the variability of the duration was significantly greater in the rocuronium group than in the cisatracurium group. Mean time of recovery was significantly longer for the elderly group receiving rocuronium than for the elderly group receiving cisatracurium (P = 0.022), and variability was also greater (P = 0.002). Both drugs favored good intubating conditions. In conclusion, cisatracurium showed less variability in these parameters than rocuronium, especially in the elderly, a fact that may be of particular clinical interest.