Administration of Neostigmine, Sugammadex, and/or Edrophonium before extubation for cases with non-depolarizing neuromuscular blockade.
Postoperative residual neuromuscular blockade can lead to significant complications.1,2 Several studies have found associations between the use of neuromuscular blockade agents (NMBA) and residual neuromuscular blockade in the recovery room. Adverse postoperative respiratory outcomes are even more frequent when patients receive NMBA and reversal agents are not used. A mainstay of residual blockade prevention continues to be monitoring to allow for detection, and use of reversal agents like neostigmine and sugammadex.3-5 Due to variability in duration of muscle relaxants, even in defasciculating doses, we recommend that TOF is monitored when any non-depolarizing neuromuscular blockers are administered.
Anesthesia Start to Earliest Extubation
All patients that have received a non-depolarizing neuromuscular blocker (NMB) AND were extubated post-operatively.
The following NMBs given as bolus, defasciculating doses or infusion are included and require reversal:
Documentation of neostigmine, Sugammadex, and/or edrophonium before earliest extubation OR An acceleromyography ratio of ≥ 0.9 documented after last dose of NMB and before earliest extubation.
Cases that recieve defasciculating doses of NMBs are included in this measure and require documentation of neostigmine, sugammadex or edrophonium before earliest extubation to pass.
The provider(s) signed in at time of earliest extubation.
Train of Four
|Date Reviewed||Reviewer||Institution||Summary||QC Vote|
Remove Cardiac exclusion: per Cardiac Subcommittee
Remove 3 hour period of no NMB as marker of success
Remove 2 hour period of no NMB as marker of success: per Pediatric Subcommittee
Remove defasciculating dose exclusion