Article Data

  • Views 2137
  • Dowloads 199

Original Research

Open Access

Neuromuscular blockade in clinical practice in paediatric anaesthesia: retrospective cohort trial in a tertiary paediatric anaesthesia centre


1Department of Paediatric Anaesthesiology and Intensive Care Medicine, University Hospital Brno, Faculty of Medicine, Masaryk University, Brno, Czech Republic

2 Faculty of Medicine, Masaryk University, Brno, Czech Republic

DOI: 10.22514/SV141.042018.10 Vol.14,Issue 1,March 2018 pp.59-62

Published: 27 March 2018

*Corresponding Author(s): PETR ŠTOURAČ E-mail:


Background. Neuromuscular blockade is associated with improved airway condi-tions for intubation and superior condi-tions for surgical interventions (predomi-nantly important in laparoscopic surgery). Residual neuromuscular blockade in the postoperative period is, according to re-cently published data, associated with a negative impact on perioperative morbid-ity and mortality. 

Aim. The aim of the study was to describe daily practice in clinical paediatric anaes-thesia in a tertiary children’s hospital. Methods. Data from anaesthesiology records during the period 1.1.2016 to 31.12.2016 were retrospectively screened. Primary outcomes included the rate of surgery cases with neuromuscular block-ade, the incidence of cases with periop-erative neuromuscular blockade monitor-ing and the incidence of neuromuscular pharmacologic block reversal. Secondary outcomes were myorelaxant usage accord-ing to the age of patients and duration of surgery.   

Results. Overall 8046 paediatric patients underwent general anaesthesia in the study period. Muscle relaxants were adminis-tered in 1650 cases (20.5%). The most fre-quently administered muscle relaxant was mivacurium (48.2 %, n=795), followed by cis-atracurium (36.4 %, n=601), suxame-thonium (10.3 %, n=170) and rocuronium (7.0 %, n=115). Neuromuscular blockade monitoring was used only in 2.5% (n=41) of cases. Active neuromuscular blockade reversal was administered in 5.8% (n=95) of cases.Conclusion. Neuromuscular blockade in paediatric anaesthesia was less frequent compared to adults. The low rate of neuro-muscular blockade monitoring in combi-nation with the low rate of active block re-versal can be considered dangerous due to the relatively high risk of potential residual postoperative blockade, that can negatively influence clinical outcome. 


neuromuscular blocking agent, paediatric anaesthesia, residual blockade, neuromuscular blockade

Cite and Share

JOZEF KLUČKA,MICHAELA ŤOUKALKOVÁ,IVO KŘIKAVA,ROMAN ŠTOUDEK,EVA KLABUSAYOVÁ,MÁRIA MORAVSKÁ,PETR ŠTOURAČ. Neuromuscular blockade in clinical practice in paediatric anaesthesia: retrospective cohort trial in a tertiary paediatric anaesthesia centre. Signa Vitae. 2018. 14(1);59-62.


1. Julien-Marsollier, F, Michelet, D, Bellon, M, Horlin, AL, Devys, JM, Dahmani, S. Muscle relaxation for tracheal intubation during paediatric anaesthesia: a meta-analysis and trial sequential analysis. Eur J Anaesthesiol. 2017 Aug;34(8):550-561.

2. Blobner M, Frick CG, Stäuble RB, Feussner H, Schaller SJ, Unterbuchner C, et al. Neuromuscular blockade improves surgical condi-tions (NISCO). Surg Endosc 2015 Mar;29(3):627-36.

3. Brandom BW, Meretoja OA, Simhi E, Taivainen T, Wolfe SR, Woelfel SK, et al. Age related variability in the effects of mivacurium in paediatric surgical patients. Can J Anaesth 1998 May;45(5 Pt 1):410-6.

4. Murphy GS, Szokol JW, Marymont JH, Greenberg SB, Avram MJ, Vender JS. Residual neuromuscular blockade and critical respira-tory events in the postanesthesia care unit. Anesth Analg 2008 Jul;107(1):130-7.

5. Brull SJ, Murphy GS. Residual neuromuscular block: lessons unlearned. Part II: methods to reduce the risk of residual weakness. Anesth Analg 2010 Jul;111(1):129-40.

6. Naguib M, Kopman AF, Ensor JE. Neuromuscular monitoring and postoperative residual curarisation: a meta-analysis. Br J Anaesth 2007 Mar;98(3):302-16.

7. Murphy GS, Szokol JW, Marymont JH, Franklin M, Avram MJ, Vender JS. Residual paralysis at the time of tracheal extubation. An-esth Analg 2005 Jun;100(6):1840-5.

8. Esteves S, Martins M, Barros F, Barros F, Canas M, Vitor P, et al. Incidence of postoperative residual neuromuscular blockade in the postanaesthesia care unit: an observational multicentre study in Portugal. Eur J Anaesthesiol 2013 May;30(5):243-9.

9. Baillard C, Clec'h C, Catineau J, Salhi F, Gehan G, Cupa M, et al. Postoperative residual neuromuscular block: a survey of manage-ment. Br J Anaesth 2005 Nov;95(5):622-6.

10. Baillard C, Gehan G, Reboul-Marty J, Larmignat P, Samama CM, Cupa M. Residual curarization in the recovery room after vecuro-nium. Br J Anaesth 2000 Mar;84(3):394-5.

11. Bevan JC, Tousignant C, Stephenson C, Blackman L, Reimer E, Smith MF, et al. Dose responses for neostigmine and edrophonium as antagonists of mivacurium in adults and children. Anesthesiology 1996 Feb;84(2):354-61.

12. Naguib M, el-Gammal M, Daoud W, Ammar A, Moukhtar H, Turkistani A. Human plasma cholinesterase for antagonism of pro-longed mivacurium-induced neuromuscular blockade. Anesthesiology 1995 May;82(5):1288-92.

13. Davis L, Britten JJ, Morgan M. Cholinesterase. Its significance in anaesthetic practice. Anaesthesia 1997 Mar;52(3):244-60.

14. Kopman AF. Undetected residual neuromuscular block has consequences. Anesthesiology 2008 Sep;109(3):363-4.

Abstracted / indexed in

Science Citation Index Expanded (SciSearch) Created as SCI in 1964, Science Citation Index Expanded now indexes over 9,200 of the world’s most impactful journals across 178 scientific disciplines. More than 53 million records and 1.18 billion cited references date back from 1900 to present.

Journal Citation Reports/Science Edition Journal Citation Reports/Science Edition aims to evaluate a journal’s value from multiple perspectives including the journal impact factor, descriptive data about a journal’s open access content as well as contributing authors, and provide readers a transparent and publisher-neutral data & statistics information about the journal.

Chemical Abstracts Service Source Index The CAS Source Index (CASSI) Search Tool is an online resource that can quickly identify or confirm journal titles and abbreviations for publications indexed by CAS since 1907, including serial and non-serial scientific and technical publications.

Index Copernicus The Index Copernicus International (ICI) Journals database’s is an international indexation database of scientific journals. It covered international scientific journals which divided into general information, contents of individual issues, detailed bibliography (references) sections for every publication, as well as full texts of publications in the form of attached files (optional). For now, there are more than 58,000 scientific journals registered at ICI.

Geneva Foundation for Medical Education and Research The Geneva Foundation for Medical Education and Research (GFMER) is a non-profit organization established in 2002 and it works in close collaboration with the World Health Organization (WHO). The overall objectives of the Foundation are to promote and develop health education and research programs.

Scopus: CiteScore 1.0 (2022) Scopus is Elsevier's abstract and citation database launched in 2004. Scopus covers nearly 36,377 titles (22,794 active titles and 13,583 Inactive titles) from approximately 11,678 publishers, of which 34,346 are peer-reviewed journals in top-level subject fields: life sciences, social sciences, physical sciences and health sciences.

Embase Embase (often styled EMBASE for Excerpta Medica dataBASE), produced by Elsevier, is a biomedical and pharmacological database of published literature designed to support information managers and pharmacovigilance in complying with the regulatory requirements of a licensed drug.

Submission Turnaround Time