Background and Goal of the Study: Despite its high morbidity, the risk of residual neuromuscular blockade (RNB) during the perioperative period is still underestimated. We decided to describe the incidence and risk factors for RNB at our tertiary referral hospital.
Materials and methods: We retrospectively studied 240 consecutive patients that received nondepolarizing neuromuscular blocking agents (NDB) from June to December 2015. Data regarding patient history and possible risk factors were collected from the electronic medical record. RNB was defined as a train­off­our ratio (TOFr) < 0.9 at arrival postanesthesia care unit. Risk factors included in the multivariable analysis were: intra operative neuromuscular monitoring, use of reversal agents, choice of NDB, total dose of blocking agent as ED95/h and time since last NDB dose. Fischer ́s exact test or chi­square test were run for the comparison of categorical variables.
Results and discussion: Total RNB incidence was 24% (58/240). Only one patient with intraoperative neuromuscular monitoring (1/63) presented RNB as compared with (57/177) of the non-monitored group (2% vs. 31%, respectively; p< 0.001). Multivariable regression analysis showed that ED95/h was associated with a fivefold increase of RNB risk. The use of intraoperative monitoring was a strong protective factor for RNB, followed by rocuronium and sugammadex use. Intraoperative reversal agents were used in 75 patients. Despite its use, RNB was present in 25% of the non-monitored patients. No patient in the monitored group developed RNB (6/24 vs. 0/51, respectively; p=0,003).
Conclusions: Intraoperative neuromuscular monitoring played a key role in preventing followed by rocuronium and sugammadex use. Total dose of blocking agent was a strong predictor of RNB risk.

We have everything to succeed, but we fail to prevent residual neuromuscular blockade