INCIDENCE, RISK FACTORS, AND ADVERSE OUTCOMES OF RESIDUAL NEUROMUSCULAR BLOCKADE IN OLDER ADULTS UNDERGOING LAPAROSCOPIC ABDOMINAL SURGERY: A PROSPECTIVE OBSERVATIONAL STUDY WITH QUANTITATIVE TRAIN-OF-FOUR MONITORING
DOI:
https://doi.org/10.18623/rvd.v23.6474Keywords:
Residual Neuromuscular Blockade, Train-of-Four, Rocuronium, Postoperative ComplicationsAbstract
Background: Residual neuromuscular blockade (RNMB) may compromise perioperative safety by impairing respiration, delaying recovery, and predisposing to postoperative complications. The cardiopulmonary effects of laparoscopic surgery may further increase susceptibility in elderly patients. Objectives: To determine the incidence of RNMB, identify perioperative risk factors, and evaluate its association with postoperative adverse outcomes in geriatric patients undergoing laparoscopic surgery. Materials and Methods: We conducted a prospective observational study of patients aged ≥65 years who underwent laparoscopic abdominal surgery between May 2023 and June 2024. General anesthesia included non-depolarizing neuromuscular blockade with routine pharmacologic reversal. Train-of-four (TOF) ratios were measured by quantitative acceleromyography (TOF-Watch) immediately after extubation (T1), at 15 minutes (T2), 30 minutes (T3), and 60 minutes (T4), with extended assessments (T5–T6) if clinically indicated. RNMB was defined as TOF <0.9 at any time point. Patients with and without RNMB were compared using appropriate independent tests, and paired analyses assessed TOF changes over time. Adverse outcomes—nausea, respiratory failure, and urinary retention—were evaluated between cohorts. Results: RNMB was most frequent at extubation and declined thereafter: 10.8% (T1), 4.4% (T2), 2.0% (T3), and 0% (T4-T6). In the RNMB cohort, median TOF ratios were 0.71 (T1), 0.81 (T2), and 0.79 (T3), with complete recovery by sixty minutes (T4-T6). Higher cumulative rocuronium dose independently increased RNMB risk (OR 1.78 per mg/kg, 95% CI 1.02–3.10; p=0.042). Sugammadex use reduced the odds of RNMB (adjusted OR 0.38, 95% CI 0.15–0.96; p=0.040). Adverse outcomes were numerically more frequent in RNMB patients but did not reach statistical significance. Conclusions: In geriatric patients undergoing laparoscopic surgery, RNMB is frequent at extubation but self-limiting, with complete recovery observed within sixty minutes postoperatively, and no statistically significant differences in adverse outcomes. The cumulative neuromuscular blockade dose is a modifiable risk factor, while the use of sugammadex independently reduces the risk of RNMB.
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