Correspondence  |   July 2017
Risk of Postoperative Pneumonia with Neuromuscular Blockade: Keep It Simple!
Author Notes
  • University of Florida College of Medicine, Gainesville, Florida (L.J.C.). lcaruso@anest.ufl.edu
  • (Accepted for publication April 13, 2017.)
    (Accepted for publication April 13, 2017.)×
Article Information
Correspondence
Correspondence   |   July 2017
Risk of Postoperative Pneumonia with Neuromuscular Blockade: Keep It Simple!
Anesthesiology 7 2017, Vol.127, 196-197. doi:10.1097/ALN.0000000000001696
Anesthesiology 7 2017, Vol.127, 196-197. doi:10.1097/ALN.0000000000001696
We read with interest the article by Bulka et al.1  regarding the relationship between the management of intraoperative neuromuscular blockade and postoperative pneumonia. The use of large databases to address rare outcomes has increased in recent years. The value in using these databases is the large number of patients who can be assessed. Such large numbers would be extremely challenging to achieve in a randomized controlled study. However, a major limitation and concern with database studies like this one is subsequent confusion between correlation and causation. With regard to residual paralysis, we believe that these challenges can be bypassed with one simple technique—the objective monitoring of the effects of a neuromuscular blocking agent. Although the incidence of residual neuromuscular blockade at extubation is significant,2  currently, monitoring of neuromuscular blockade is still not an explicitly articulated American Society of Anesthesiologists basic monitoring standard.3  Whereas many practitioners use such monitoring in their practice, others rely on clinical signs of strength or other outdated measures, such as the 5-s head lift or 50-Hz sustained tetanus to determine adequate recovery from neuromuscular blockade before extubation. Still others simply rely on time from reversal agents being given.4 
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