Şevki SARI, Bekir Suat KÜRKÇÜOĞLU, Bahar Uslu BAYHAN, Gamze Nur TEKE, Gizem KIRBAŞ, Ahmet Salih TÜZEN
Journal of Health Sciences and Medicine - 2026;9(5):1205-1211
Aims: In this retrospective observational cohort study, we estimated the incidence of postoperative residual neuromuscular blockade (RNMB) after rocuronium administration and examined its association with intraoperative quantitative neuromuscular monitoring (NMM) and reversal strategies. Methods: We analyzed 305 adults with American Society of Anesthesiologists (ASA) physical status I-III who received rocuronium under general anesthesia between January and April 2024. Patients were classified as monitored or unmonitored according to the attending anesthesiologist's preference for NMM use. Train-of-four ratio (TOFR) was measured in the post-anesthesia care unit (PACU) using TOFscan(R) acceleromyography; RNMB was defined as TOFR <0.90. Results: Overall RNMB incidence was 6.2% [19/305; 95% confidence interval (CI), 4.0-9.5]. RNMB occurred in 10.4% (19/182; 95% CI, 6.8-15.7) of unmonitored patients and 0.0% (0/123; 95% CI, 0.0-3.0) of monitored patients (p<0.001). The absolute risk difference was 10.4 percentage points (95% CI, 5.7-15.7; Newcombe method). In the monitored group, RNMB was absent in all subgroups: sugammadex (n=71), neostigmine (n=27), and no antagonist (n=25). RNMB occurred in 8.0% (13/163; 95% CI, 4.7-13.2) of unmonitored patients receiving sugammadex. In an exploratory Firth-type penalized logistic regression adjusted for ASA status, anesthetic agent, and time from the last rocuronium dose to PACU TOFR measurement, NMM use [odds ratio (OR), 0.029; 95% CI, 0.0002-0.227] and this time interval (OR per minute, 0.986; 95% CI, 0.970-0.998) were inversely associated with RNMB. Conclusion: Intraoperative NMM was associated with a lower incidence of RNMB after rocuronium administration. RNMB also occurred among unmonitored patients receiving sugammadex.
