Search

Background: Neuromuscular blocking agents (NMBAs) are routinely used in anesthesia practice. An undetected, incomplete recovery of neuromuscular function at the end of surgery potentially exposes patients to clinical deterioration in the postoperative period. The aim of this study was to investigate the incidence of postoperative residual neuromuscular blockade (RNMB) in a cohort of patients receiving NMBAs. Methods: We enrolled 90 spontaneously breathing adult patients admitted to the recovery room (RR) after completion of surgeries having received at least 1 dose of NMBA. Anesthesia management, the dosage of NMBA used, and whether monitoring of neuromonitoring function was employed or if a reversal agent was administered were all at the discretion of the attending anesthesiologist, who was unaware that neuromuscular function was going to be monitored in the RR. The primary objective of this study was to determine the incidence of RNMB (defined as a train-of-four ratio ≤ 0.9). The secondary objectives were the number of postoperative adverse respiratory events and, for exploratory purposes, the estimation of potential risk factors through logistic regression analysis. Results: RNMB occurred in 5 (5%) patients who had received only one dose of NMBA at induction of anesthesia. Two patients with RNMB (40%) required O2 supplementation during monitoring in the RR, compared to 11 patients in the rest of the sample (13%). Additionally, 2 of these patients (2%) required O2 supplementation before hospital discharge due to O2 desaturation < 92%. None of the patients with RNMB had received a reversal of neuromuscular blockade at the end of surgery. The association between RNMB and potential risk factors, assessed through multivariable logistic regression did not yield significant results for any of the considered variables. Conclusions: RNMB can occur even when a single dose of NMBAs is administered. Despite decades of extensive literature on the risks of RNMB and recent guidelines, routine monitoring of neuromuscular function and pharmacologic reversal of NMBA is still substandard. Routine monitoring of neuromuscular function is strongly advocated to enhance the level of patient care. Trial registration: The study was registered at ClinicalTrials.gov (NCT06193213, date of registration: 05/01/2024). [ABSTRACT FROM AUTHOR]

Background: Reducing a child's level of anxiety before magnetic resonance imaging (MRI) procedures allows for better behavioral outcomes. The aim of this retrospective study was to evaluate anxiolytic efficacy of Midazolam/γ-cyclodextrin oral formulation. Methods: We retrospectively reviewed 100 medical charts of children who, between 1 February and 31 July 2022, underwent MRI under general anesthesia with or without premedication with midazolam/γ-cyclodextrin. Primary outcome was comparison of behavior to facemask positioning, while secondary endpoints were degree of drugs acceptance, anxiolytic effect evaluation, child's behavior on separation, and sevoflurane need. Results: Facemask positioning was accepted by 58% of the midazolam/γ-cyclodextrin group compared to 22% of children in the control group. The rate of acceptance was >90%. At the moment of separation from parent, none of the premedicated children needed to be restrained compared to 18% in the control group. A lower percentage of sevoflurane was needed for eye-closure at induction of anesthesia and for anesthesia maintenance. At emergence from anesthesia, 46% of children in the premedicated group compared to 66% of children in the control group showed transient agitation. Conclusions: Midazolam/γ-cyclodextrin showed a good profile of acceptance, satisfactory anxiolytic properties, and reduced need for anesthetics when administered to children before MRI under general anesthesia. [ABSTRACT FROM AUTHOR]