oa Southern African Journal of Anaesthesia and Analgesia - Posttetanic facilitation : a clinical test for safe reversal of nondepolarising neuromuscular blockade : SASA 2009 Congress prize entries
During the 1970s and 1980s, regaining a train-of-four ratio (TOFR) of 0.7 after administration of non-depolarising neuromuscular blocking drugs, was regarded as an indication of return of mechanical respiratory reserve and the ability to maintain a patent airway. Evidence has accumulated that patients sent to recovery rooms with TOFR less than 0.9 have impaired function of their pharyngeal muscles that predisposes them to regurgitation and aspiration, and an increased risk for developing postoperative pulmonary complications. Furthermore it appears that a TOFR < 0.9 is associated with decreased chemoreceptor sensitivity to hypoxia. In spite of being able to maintain a sustained head lift and leg lift, patients had difficulty in swallowing, felt uncomfortable and could not sip water through a straw. Residual neuromuscular block is a major risk factor behind critical events in the immediate postoperative period and should be regarded as a serious adverse event in the same way as we regard ventilatory depression due to opioids and anaesthetic agents.
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