THE IMPACT OF IMPLEMENTATION OF NEUROMUSCULAR BLOCKADE MONITORING STANDARDS IN A SURGICAL INTENSIVE-CARE UNIT

The purpose was to determine whether implementation of standards for p eripheral nerve monitoring could decrease the incidence of neuromuscul ar dysfunction related to the administration of paralytic agents. Over a 2-year period, consecutive patients admitted to a surgical intensiv e care unit who received continuously-infused or >6 daily doses of neu romuscular blocking agents were subjected to train-of-four (TOF) monit oring of the adductor pollicis. Therapy was titrated to the maintenanc e of one to two twitches at all times. The incidence of prolonged (>12 h) paralysis after drug discontinuation was documented in these patie nts and compared to that in patients treated in the previous 12 months . The presence of electrolyte abnormalities, organ dysfunction, and co ncomitant medications was also recorded. Chi-square analysis with Yate s correction was employed. Before implementation of routine TOF monito ring, there were five instances of paralytic-associated neuromuscular dysfunction (5/43). After implementation of the TOF protocol no instan ces-of paralytic-associated neuromuscular dysfunction occurred (0/90), despite the same incidence of risk factors (100%) (P < 0.05), A proto col for neuromuscular blockade monitoring is efficacious in preventing paralytic-associated neuromuscular dysfunction. This can be a cost-ef fective measure, minimizing the prolonged mechanical ventilation and i ntensive rehabilitation required secondary to unmonitored use of neuro muscular blocking agents.