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NEUROMUSCULAR MONITORING DURING GENERAL ANESTHESIA:

BENEFITS IN REDUCING POSTOPERATIVE COMPLICATIONS

João Pedro do Valle Varela1

Ana Clara Berzoini Albuquerque2

Fabio Sandoval Pickert3

Danielle Rezende4

Julia Bandeira Lima5

Yasmin Oliveira Gil de Almeida6

Luiza Lucindo Lakatos7

Jaqueline Carrara Folly Valente8

Vinicius Augusto Rocha Pompermayer9

Sidney Pereira Ramos Júnior10

Débora Guimarães Cunha11

Bárbara Wagmacker Barbosa12

Debora Wagmacker Barbosa13

Rebeca Seraphim Veronez14

1 Metropolitan College São Carlos

2 Federal University of Juiz de Fora

3 Brazilian Multivix Faculty Vitória

4 Metropolitan College São Carlos

5 Vila Velha University

6 Brazilian Multivix College of Cachoeiro de Itapemirim

7 University of Vassouras

8 Federal University of Espírito Santo

9 State University ofMontes Claros

10 State University of Montes Claros

11 State University of Montes Claros

12 Federal University of Espírito Santo

13 Brazilian Multivix Faculty Vitória

14 Vila Velha University

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Camila Teles Rodrigues15

Abstract: Neuromuscular monitoring during general anaesthesia is a crucial practice for the proper

management of muscle blocks, allowing the dosage of muscle relaxants to be optimized and adverse

eects to be minimized. The use of neuromuscular blocking agents is common in surgery, especially

to facilitate intubation and muscle relaxation. However, inappropriate or excessive use of these agents

can result in post-operative complications, such as residual muscle weakness, breathing diculties

and delayed recovery. Neuromuscular monitoring has proven to be an essential tool for mitigating

these risks. The aim of this study is to evaluate the benets of neuromuscular monitoring during

general anesthesia, with a focus on reducing postoperative complications such as residual muscle

weakness, respiratory diculty and prolonged recovery time. The aim is also to compare the results

of patients who receive real-time monitoring with those who do not. This is a qualitative literature

review whose aim is to explore the implications of neuromuscular monitoring in anesthetic practices

and its eects on postoperative recovery, opioid consumption and residual neuromuscular blockade.

To this end, the PubMed, Scopus and Web of Science databases will be used. The review will be

rened using health descriptors such as “Neuromuscular Monitoring,” “Residual Paralysis,” “Opioid

Consumption,” with a time frame from 1998 to 2020, covering both review articles and clinical studies

and randomized trials. Neuromuscular monitoring has shown clear benets in reducing residual

muscle weakness and improving postoperative respiratory function. Studies indicate that patients

who use real-time monitoring during general anesthesia have shorter recovery times, lower rates of

respiratory complications and less need for assisted ventilation. In addition, monitoring allows for

more precise dosing of muscle relaxants, avoiding overuse and the occurrence of adverse eects. When

applied correctly, monitoring also contributes to reducing the duration of anesthesia and improves the

patient’s post-operative experience. Neuromuscular monitoring during general anesthesia is essential

for reducing postoperative complications, especially residual muscle weakness and respiratory

15 Vila Velha University

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diculty. Its eective use contributes to a faster and safer recovery for patients, allowing healthcare

professionals to adjust the dosage of muscle blockers more precisely. The widespread implementation

of this practice in surgical centers is recommended to optimize anesthetic management and improve

postoperative outcomes.

Keywords: Anesthesiology; Neuromuscular Monitoring; General Anesthesia.

INTRODUCTION

Neuromuscular monitoring during general anesthesia has been consolidated as an essential

practice in anesthetic medicine, with the aim of optimizing the management of neuromuscular blockers

used during surgical procedures. The use of muscle relaxant agents is common in many interventions,

especially those that require tracheal intubation, making it easier to perform maneuvers that would

otherwise be dicult. However, adequate monitoring of the depth of neuromuscular blockade during

general anesthesia is crucial to avoid complications, such as residual paralysis, which can negatively

impact patient recovery (KHETERPAL et al., 2009). Accurate monitoring, therefore, plays a key role in

reducing the risks associated with anesthesia and improving postoperative outcomes, including faster

and safer recovery of patients.

In many clinical practices, the assessment of neuromuscular blockade intensity is performed

with the aid of monitoring devices, such as the peripheral nerve response monitor, which allow for

accurate quantication of muscle relaxation. These systems provide real-time data on the depth of the

blockade, helping anesthesiologists adjust the doses of anesthetic agents and muscle relaxants, avoiding

both over- and under-dosing (SEYMOUR et al., 2010). With this monitoring, it is possible to ensure that

the block is sucient for the procedure without resulting in unwanted adverse eects such as residual

paralysis.

The reduction of postoperative complications, such as respiratory failure and diculties in

recovering muscle function, is one of the main benets of neuromuscular monitoring. Studies indicate

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that monitoring during general anesthesia is related to a decreased incidence of respiratory complications,

such as hypoxemia and respiratory failure, which can occur when neuromuscular blockade is not fully

reversed (RAMPIL, 1998). In addition, proper neuromuscular monitoring can improve eciency

in reversing muscle blockade, resulting in a faster recovery of muscle function and, consequently,

decreasing the need for prolonged mechanical ventilation or reintubation.

Therefore, neuromuscular monitoring in general anesthesia not only facilitates the surgical

procedure itself, but also plays a signicant role in preventing postoperative complications, favoring a

safer and faster recovery of patients. The evolution of monitoring technologies has allowed for more

precise control, expanding the benets of this practice and having a direct impact on reducing the risks

associated with inappropriate muscle blockages.

MATERIALS AND METHODS

This is a qualitative literature review, whose objective is to explore the implications of

neuromuscular monitoring in anesthetic practices and its eects on postoperative recovery, opioid

consumption, and residual neuromuscular blockade. For this, the PubMed, Scopus and Web of Science

databases will be used. The review will be rened using health descriptors such as “Neuromuscular

Monitoring,” “Residual Paralysis,” “Opioid Consumption,” with a time frame from 1998 to 2020,

covering both review articles and clinical studies and randomized trials.

1. Guiding Question:

How does neuromuscular monitoring impact anesthetic recovery, opioid consumption, and the

risk of residual neuromuscular blockade in patients undergoing surgical procedures?

2. Databases Used

PubMed

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Scopus

Web of Science

3. Health Descriptors and Boolean Markers

Health descriptors were used in the MeSH/DeCS vocabulary:

Descriptors:

“Neuromuscular Monitoring”

“Residual Paralysis”

“Opioid Consumption”

“Anesthesia”

“Anesthesiology”

“Perioperative Care”

Boolean Markers:

“Neuromuscular Monitoring” AND “Opioid Consumption”

“Residual Paralysis” AND “Recovery”

“Neuromuscular Blockade” AND “Anesthesia” AND “Recovery”

“Neuromuscular Monitoring” AND “Residual Paralysis” AND “Opioid Use”

4. Inclusion and Exclusion Criteria

Inclusion Criteria:

Studies published between 1998 and 2020;

Peer-reviewed articles, including clinical trials, systematic reviews, meta-analyses, and

guidelines;

Studies focused on neuromuscular monitoring and its eects on anesthesia and postoperatively;

Publications in English.

Exclusion Criteria:

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Studies not focused on anaesthesia or neuromuscular monitoring;

Works exclusively related to pediatric anesthesia or other age groups irrelevant to the research;

Articles without comparative data on the eects of neuromuscular monitoring.

THEORETICAL FOUNDATION

Neuromuscular monitoring during general anesthesia is crucial to ensure patient safety,

especially when the use of neuromuscular blockers is required. These drugs have the function of

relaxing skeletal muscles, facilitating endotracheal intubation and providing ideal conditions for surgery.

However, to avoid complications associated with over- or under-use of these drugs, it is essential to

monitor the depth of neuromuscular blockade. Proper monitoring not only allows for the administration

of more accurate doses, but also reduces the risk of respiratory complications, such as residual paralysis,

which can prolong postoperative recovery time and increase morbidity (NAGUIB and BRULL, 2020).

Monitoring of neuromuscular function can be performed by several methods, the most

commonly used being peripheral nerve response devices, such as peripheral nerve stimulators (PNS).

This device allows the electrical stimulation of a peripheral nerve and the observation of the muscle

response, which makes it possible to evaluate the depth of the muscle block. This assessment is essential

for anesthesiologists to adjust the dosage of the neuromuscular blocker appropriately, avoiding residual

paralysis and respiratory compromise (ELIA et al., 2018). An adequate muscle response to stimuli can

indicate the appropriate time for block reversal, ensuring that the patient recovers muscle function

eciently and without complications.

Residual paralysis is one of the main risks associated with the inappropriate use of

neuromuscular blockers. It occurs when the patient still shows signs of paralysis after surgery, which

can lead to breathing diculties, hypoventilation, and, in more severe cases, the need for reintubation

(KHAMIEES et al., 2020). Continuous neuromuscular monitoring allows these signs to be detected

early, facilitating complete reversal of the blockade before serious complications occur. The use of

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monitoring techniques has been shown to be eective in reducing the incidence of residual paralysis and

improving postoperative respiratory outcome (SEYMOUR et al., 2020).

In addition, neuromuscular monitoring is directly related to optimizing the reversal of muscle

blocks. When the blockade is monitored eciently, the administration of reversing agents, such as

neostigmine or sugammadex, can be done more precisely, avoiding the overuse of anticholinesterase

drugs and accelerating the recovery of muscle function. This results in a faster and safer recovery, as well

as minimizing the need for postoperative mechanical ventilation (NAGELHOUT and PLAUS, 2019). A

successful reversal of neuromuscular blockade reduces the incidence of respiratory complications and

contributes to improved post-surgical outcomes.

Another important aspect is the impact of neuromuscular monitoring on reducing the use of

opioid analgesics in the postoperative period. When neuromuscular blockade is properly monitored and

reversible, the patient experiences less pain due to rapid recovery of muscle function, which decreases

the need for strong painkillers. This, in turn, reduces opioid side eects such as respiratory depression

and constipation, promoting a more comfortable and safer recovery (KHAN et al., 2020).

In conclusion, neuromuscular monitoring during general anesthesia plays an essential role

in reducing postoperative complications, allowing for more accurate administration of neuromuscular

blockers and ensuring complete reversal of the blockade. By reducing the risks of residual paralysis

and respiratory complications, this practice has a positive impact on patient recovery, improving post-

surgical outcomes and promoting a faster and safer recovery.

CONCLUSION

Neuromuscular monitoring during general anesthesia is an indispensable tool to ensure safety

and ecacy in the management of neuromuscular blockade, especially in patients who require complex

surgical procedures. Proper use of monitoring devices has been shown to signicantly reduce the risk

of residual paralysis, one of the main factors contributing to postoperative respiratory complications.

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Continuous monitoring allows anesthesiologists to precisely adjust the dosage of neuromuscular

blockers, promoting eective and faster reversal of muscle blockage. This not only speeds up the patient’s

recovery but also decreases the need for mechanical ventilation, contributing to a more comfortable and

safer recovery.

In addition, neuromuscular monitoring is directly associated with decreased use of opioid

analgesics in the postoperative period, which reduces the side eects of these drugs and improves

the quality of the patient’s recovery. Systematic implementation of this practice is therefore crucial to

optimize postoperative outcomes and promote faster and more ecient recovery. By reducing respiratory

complications and accelerating muscle block reversal, neuromuscular monitoring is an essential

component to improve surgical outcomes and promote patient safety throughout the perioperative

process.

In summary, neuromuscular monitoring represents a signicant advance in modern anesthesia,

with direct implications for the quality of post-surgical recovery, the reduction of respiratory complications,

and the increase in overall patient safety. Its continuous integration into anesthetic practices is essential

to ensure better outcomes and optimize perioperative care, reecting an increasingly grounded and

precise practice in the eld of anesthesiology.

REFERENCES

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monitoring on recovery after anesthesia: A prospective randomized trial. Anesthesiology, 110(2), 271-

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RAMPIL, I. J. (1998). A primer on the use of neuromuscular monitoring. Anesthesia & Analgesia,

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SEYMOUR, C., KOHN, T., & et al. (2010). Neuromuscular monitoring in anesthetic practice. British

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