Monitoring and Antagonism of Neuromuscular Blockade

- Introduction

Recent data indicated a high incidence of inappropriate management of neuromuscular block, with a high rate of residual paralysis and relaxant-associated postoperative complications. These data are alarming in that the available neuromuscular monitoring, as well as myorelaxants and their antagonists basically allow well tolerated management of neuromuscular blockade.

In 2023, both the American Society of Anesthesiologists (ASA) and European Society of Anaesthesiology and Intensive Care (ESAIC) published guidelines on the management of neuromuscular blockade [1,2]. Their aim was to present aggregated and evidence-based recommendations to assist clinicians provide best medical care and ensure patient safety. The guidance focuses primarily on the type and site of monitoring and the process of antagonizing neuromuscular blockade to reduce residual blockade. Both societies strongly recommend the use of objective monitors whenever neuromuscular blocking agents (NMBAs) are administered. The 2026 UpToDate topic on monitoring neuromuscular blockade, authored by Renew and Joshi [3], highlights the critical shift toward objective, quantitative monitoring to prevent postoperative residual neuromuscular blockade (RNMB).

This Egyptian Guideline was made in accordance with the 2023 American Society of Anesthesiologists Practice Guidelines for Monitoring and Antagonism of Neuromuscular Blockade: A Report by the American Society of Anesthesiologists Task Force on Neuromuscular Blockade.