{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,23]],"date-time":"2025-12-23T15:43:02Z","timestamp":1766504582040,"version":"build-2065373602"},"reference-count":32,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2023,5,2]],"date-time":"2023-05-02T00:00:00Z","timestamp":1682985600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>We aimed to determine if not using residual neuromuscular blockade (RNB) analysis to guide neuromuscular blockade reversal administration in the postsurgical ICU resulted in consequences related to residual weakness. This single-center, prospective study evaluated 104 patients arriving in a postcardiac surgical ICU. After demonstrating spontaneous movement and T &gt; 35.5 \u00b0C, all patients underwent RNB evaluation, and neostigmine\/glycopyrrolate was then administered. When patients later demonstrated an adequate Rapid Shallow Breathing Index, negative inspiratory force generation, and arterial blood gas values with minimal mechanical ventilatory support, RNB evaluation was repeated in 94 of the 104 patients, and all patients were extubated. Though RNB evaluation was performed, patients were extubated without considering these results. Eleven of one hundred four patients had not achieved a Train-of-Four (TOF) count of four prior to receiving neostigmine. Twenty of ninety-four patients demonstrated a TOF ratio \u2264 90% prior to extubation. Three patients received unplanned postextubation adjunct respiratory support\u2014one for obvious respiratory weakness, one for pain-related splinting compounding baseline disordered breathing but without obvious benefit from BiPAP, and one for a new issue requiring surgery. Residual neuromuscular weakness may have been unrecognized before extubation in 1 of 104 patients administered neostigmine without RNB analysis. ICU-level care may mitigate consequences in such cases.<\/jats:p>","DOI":"10.3390\/jcm12093253","type":"journal-article","created":{"date-parts":[[2023,5,3]],"date-time":"2023-05-03T01:36:38Z","timestamp":1683077798000},"page":"3253","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Reversing Neuromuscular Blockade without Nerve Stimulator Guidance in a Postsurgical ICU\u2014An Observational Study"],"prefix":"10.3390","volume":"12","author":[{"given":"Andrea","family":"Calef","sequence":"first","affiliation":[{"name":"Department of Surgery, Johns Hopkins Hospital, Baltimore, MD 21287, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rashel","family":"Castelgrande","sequence":"additional","affiliation":[{"name":"Department of Surgery, Anne Arundel Medical Center, Anne Arundel, MD 21401, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kristin","family":"Crawley","sequence":"additional","affiliation":[{"name":"Department of Surgery, Medstar Medical Group, Baltimore, MD 21201, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sara","family":"Dorris","sequence":"additional","affiliation":[{"name":"Department of Surgery, Johns Hopkins Hospital, Baltimore, MD 21287, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joanna","family":"Durham","sequence":"additional","affiliation":[{"name":"Department of Surgery, Johns Hopkins Hospital, Baltimore, MD 21287, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kaitlin","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Surgery, Johns Hopkins Hospital, Baltimore, MD 21287, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jen","family":"Paras","sequence":"additional","affiliation":[{"name":"Department of Surgery, INOVA Fairfax Hospital, Fairfax, VA 22042, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kristen","family":"Piazza","sequence":"additional","affiliation":[{"name":"Department of Surgery, University of Maryland St Joseph Hospital, Baltimore, MD 21201, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Abigail","family":"Race","sequence":"additional","affiliation":[{"name":"Department of Surgery, North Shore University Hospital, Manhasset, NY 11030, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Laura","family":"Rider","sequence":"additional","affiliation":[{"name":"Department of Surgery, Johns Hopkins Hospital, Baltimore, MD 21287, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael","family":"Shelley","sequence":"additional","affiliation":[{"name":"Department of Surgery, Maine Medical Center, Portland, ME 04103, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Emily","family":"Stewart","sequence":"additional","affiliation":[{"name":"Department of Surgery, Johns Hopkins Hospital, Baltimore, MD 21287, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Miranda","family":"Tamok","sequence":"additional","affiliation":[{"name":"Department of Surgery, Johns Hopkins Hospital, Baltimore, MD 21287, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jennifer","family":"Tate","sequence":"additional","affiliation":[{"name":"Department of Surgery, Johns Hopkins Hospital, Baltimore, MD 21287, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jeffrey M.","family":"Dodd-o","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Johns Hopkins Hospital, Baltimore, MD 21287, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2023,5,2]]},"reference":[{"key":"ref_1","first-page":"45","article-title":"Monitoring of Neuromuscular Blockade: What Would You Expect If You Were the Patient?","volume":"30","author":"Stoelting","year":"2016","journal-title":"APSF Newsl."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"173","DOI":"10.1097\/ALN.0000000000001409","article-title":"Current Status of Neuromuscular Reversal and Monitoring: Challenges and Opportunities","volume":"126","author":"Brull","year":"2017","journal-title":"Anesthesiology"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"130","DOI":"10.1213\/ane.0b013e31816d1268","article-title":"Residual neuromuscular blockade and critical respiratory events in the postanesthesia care unit","volume":"107","author":"Murphy","year":"2008","journal-title":"Anesth. 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