Incidence of Postoperative Neuromuscular Blockade in Post-Anesthesia Care Unit at Parkland Hospital: Does Size Matter?

Study Overview
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Brief Summary
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This prospective, observational study will assess 100 subjects in the post-anesthesia care unit (PACU) at Parkland Hospital. Upon arrival to the PACU, patients' train-of-four (TOF) ratio will be calculated using the StimPod NMS450 accelerometer to determine the presence of any residual paralysis. Any patient with a TOF ratio < 0.9 will be reassessed every 10 minutes until the ratio is ≥0.90. The time it takes to reach a TOF ratio ≥0.9 will be recorded. Subjects will be classified according to BMI categories: lean as <30 kg/m2, obese as 30≤BMI≤39.9 kg/m2, and morbidly obese as BMI ≥40 kg/m2. This data will serve as a baseline to assess the incidence of residual NMB that currently occurs in our PACU so that we may use this pilot data to design future studies that aim to reduce the incidence of residual NMB.

Detailed Description
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Upon arrival to the PACU, patients enrolled in the study will be evaluated for residual paralysis with train-of-four (TOF) stimulation using the StimPod NMS450 accelerometer set to 30 mA. Any patients who have residual paralysis will be assessed Q10 minutes until the TOF ratio is ≥0.9. The time to achieve a TOF ratio ≥0.9 will be recorded. Any adverse events (e.g., hypoxia, reintubation, aspiration) that arise during the patient's PACU stay will be documented.

Official Title
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Incidence of Postoperative Neuromuscular Blockade in the Post-Anesthesia Care Unit at Parkland Hospital: Does Size Matter?

Conditions
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Residual Neuromuscular Blockade

Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: 18-80 years old Undergoing non-emergent surgery with general endotracheal anesthesia ASA physical status classification 1 to 4 Willing and able to consent in English or Spanish No personal history of neuromuscular disease Exclusion Criteria: Age less than 18 or older than 80 Patient does not speak English or Spanish Planned postoperative intubation or ICU admission Allergy to sugammadex, neostigmine, glycopyrrolate, or rocuronium Family or personal history of malignant hyperthermia Patient refusal Monitored anesthesia care (MAC) or regional anesthesia planned Pregnant or nursing women Stat (emergent) cases Estimated creatinine clearance <30 mL/min Pre-existing muscle weakness of any etiology

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 80 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Lean<br>BMI less than or equal to 29.9 | |
| Obese<br>BMI between 30.0 and 39.9 | |
| Morbidly Obese<br>BMI greater than or equal to 40.0 | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Incidence of Residual Neuromuscular Blockade | To establish the current incidence of postoperative residual neuromuscular blockade (NMB), defined as a train-of-four ratio <0.9, in patients upon arrival to the PACU. | 1 day on arrival to PACU | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Comparison of RNMB in Lean, Obese, and Morbidly Obese Patients | To assess the differences in the incidence of postoperative residual neuromuscular blockade (NMB) among PACU patients categorized based on body mass index (BMI) (lean, obese, and morbidly obese). | 1 day on arrival to PACU |