Post-operative residual paralysis after use of atracurium or cisatracurium in main operating theatres post anaesthesia care unit of the Kenyatta National Hospital

Abstract

Background: Neuromuscular blocking drugs are r-outinely used in major operations especially those that require muscle relaxation. Adequate muscle relaxation creates optimal conditions for easy access of the site of operation. After the operation the effects of most of these drugs if not all have to be J'eversed by the appropriate antagoniSt. Occasionally the effects are not adequately reversed and the patients may have some degree of residual paralysis. Complete reversal can be assessed clinically or objectively using a nerve stimulator after the administration of the reversal agent. Adequate reversal eliminates the possibility of residual paralysis and therefore prevention of the associate complications. Methodology: The study was an observational descriptive study. It was carried out in the main theatres post anaesthesia care unit of the Kenyatta National Hospital. Data was captured electronically using SPSS and analysiS done using SPSS version 17 and presented graphically. Residual paralysis was assessed clinically using head lift for five seconds and holding tongue depressor between the incrsors and objectively by measuring TOFR using TOF watch on the ulnar nerve. Results: A total of 263 patients aged between 18 and 65 years who had undergone elective surgery were assessed. Post operative residual paralysis was found to be about 14% and 50% using clinical and objective assessment respectively on arrival to post anaesthesia care unit. A TOFR ratio of less than 0.9 was used to indicate residual paralysis. Conclusion: There is significant Post operative residual paralysis in the main operating theatres post anaesthesia care unit of the Kenyatta National hospital. This was found to be higher using clinical assessment as compared to objective assessment using the TOFR.