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Correspondence  |   September 2013
Postanesthesia Evaluation of Neuromuscular Function
Author Affiliations & Notes
  • Aaron F. Kopman, M.D.
    Weill Cornell Medical College, New York, New York. akopman@nyc.rr.com
  • (Accepted for publication May 22, 2013.)
    (Accepted for publication May 22, 2013.)×
Article Information
Correspondence
Correspondence   |   September 2013
Postanesthesia Evaluation of Neuromuscular Function
Anesthesiology 09 2013, Vol.119, 729. doi:10.1097/ALN.0b013e31829ff1f3
Anesthesiology 09 2013, Vol.119, 729. doi:10.1097/ALN.0b013e31829ff1f3
To the Editor:
The American Society of Anesthesiologists’ recently published Practice Guidelines for Postanesthetic Care1  contains a statement that is at best puzzling and at worst I believe sends the wrong message to the anesthesia community. To quote: “Assessment of neuromuscular function primarily includes physical examination and, on occasion, may include neuromuscular blockade monitoring.”
There is now overwhelming evidence that traditional bedside or clinical tests of neuromuscular function such as head-lift, tidal volume, tongue protrusion, and others are very insensitive tests for the detection of residual neuromuscular weakness.2–5  To cite just one recent study “a reliable clinical test for detection of significant residual block... will probably remain elusive.”6  Thus one must ask what clinical signs the Task Force is referring to when they recommend a “physical examination”?
The answer to the problem of postoperative residual neuromuscular block lies not with a postanesthesia evaluation, but with intelligent intraoperative monitoring of neuromuscular function ideally with a quantitative monitor.
References
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Dupuis, JY, Martin, R, Tétrault, JP Clinical, electrical and mechanical correlations during recovery from neuromuscular blockade with vecuronium.. Can J Anaesth. (1990). 37 192–6 [Article] [PubMed]
Sharpe, MD, Lam, AM, Nicholas, JF, Chung, DC, Merchant, R, Alyafi, W, Beauchamp, R Correlation between integrated evoked EMG and respiratory function following atracurium administration in unanaesthetized humans.. Can J Anaesth. (1990). 37 307–12 [Article] [PubMed]
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Heier, T, Caldwell, JE, Feiner, JR, Liu, L, Ward, T, Wright, PM Relationship between normalized adductor pollicis train-of-four ratio and manifestations of residual neuromuscular block: A study using acceleromyography during near steady-state concentrations of mivacurium.. Anesthesiology. (2010). 113 825–32 [Article] [PubMed]