Residual Paralysis Induced by Either Vecuronium or Rocuronium After Reversal with Pyridostigmine

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Abstract
We investigated postoperative residual curarization af- ter administration of either vecuronium or rocuronium with reversal by pyridostigmine in 602 consecutive pa- tients without perioperative neuromuscular monitor- ing. On arrival in the recovery room, neuromuscular function was assessed both by acceleromyography in a train-of-four (TOF) pattern and also clinically by the ability to sustain a head-lift for 5 s and the tongue- depressor test. Postoperative residual curarization was defined as a TOF ratio 0.7. One fifth of 602 patients (vecuronium, 24.7%; rocuronium, 14.7%) had a TOF 0.7 in the recovery room. There were no significant differences in the TOF ratios between 10 mg and 20 mg of pyridostigmine. The patients with residual block had several associated factors: the absence of perioperative neuromuscular monitoring, the use of pyridostigmine, which is less potent than neostigmine, a larger dose of vecuronium, shorter time from the last neuromuscular blocker to TOF monitoring, or peripheral cooling. We conclude that significant residual neuromuscular block after vecuronium or rocuronium was not eliminated even with reversal by a large dose of pyridostigmine. (Anesth Analg 2002;95:1656 -60)