Quantifying the effect and variability of neuromuscular blocking drugs on patients undergoing surgery.

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Neuromuscular blocking drugs (NMB) are commonly used during anaesthesia to provide muscle relaxation to facilitate surgery. Although various agents can be used to antagonise the residual effect of these drugs at the end of surgery there is clear evidence that a proportion of patients have residual effects of these drugs in the recovery (PACU) area and that this may be associated with increased morbidity in the post-operative period. These residual effects can be minimised by careful use and monitoring of these drugs and effects. New monitoring modalities (NMT monitors) allow us to more accurately measure the degree of paralysis produced by these drugs. We also have tools that calculate the levels of NMB drugs in the body. We have empirically observed that there is a large inter-patient variability in the drug levels associated with a given degree of blockade, but an individual patient will have a similar response at a similar drug level after repeated doses of NMBs. While NMBs are used in less than 50% of anaesthetics, with changes in surgical practice there is an increasing requirement for “deeper” block at the same time as the dangers of residual effects are being increasingly recognised. Newer tools allow us to better titrate and manage these drugs. The primary purpose of this study is to quantify variability in patient response, using routine clinical tools, to give us an understanding of how we can use these tools to improve care. Specific follow-up will allow us to relate quality of recovery to usage of NMB drugs.

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