Residual Paralysis: Does it Influence Outcome After Ambulatory Surgery?

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• Eikermann M, Fassbender P, Malhotra A, et al. Unwarranted administration of acetylcholinesterase inhibitors can impair genioglossus and diaphragm muscle function. Anesthesiology. 2007;107(4):621–629. doi: 10.1097/01.anes.0000281928.88997.95 . This preclinical paper demonstrated that neostigmine administration following recovery from neuromuscular blockade dose-dependently impairs respiratory muscle function and breathing.

•• Herbstreit F, Zigrahn D, Ochterbeck C, Peters J, Eikermann M. Neostigmine/glycopyrrolate administered after recovery from neuromuscular block increases upper airway collapsibility by decreasing genioglossus muscle activity in response to negative pharyngeal pressure. Anesthesiology. 2010;113(6):1280–1288. doi: 10.1097/ALN.0b013e3181f70f3d . This paper demonstrates that neostigmine given following recovery from neuromuscular blockade impairs upper airway muscle function and increases airway collapsibility.

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• Ma D, Zhang B, Hoffmann U, Sundrup MG, Eikermann M, Isaacs L. Acyclic cucurbit[n]uril-type molecular containers bind neuromuscular blocking agents in vitro and reverse neuromuscular block in vivo. Angew Chem Int Ed Engl. 2012;51(45):11358–11362. doi: 10.1002/anie.201206031 . First description of the development of calabadions, acyclic cucurbit[n]uril-type molecular containers which bind neuromuscular blocking agents in vitro and reverse neuromuscular block in vivo.

• Hoffmann U, Grosse-Sundrup M, Eikermann-Haerter K, et al. Calabadion: a new agent to reverse the effects of benzylisoquinoline and steroidal neuromuscular-blocking agents. Anesthesiology. 2013;119(2):317–325. doi: 10.1097/ALN.0b013e3182910213 . Describes calabadion, a new broad-spectum drug to reverse the effects of cisatracurium and rocuronium.

Moreno-Duarte I, Haerter F, Simons J, et al. Calabadion II reverses steroidal neuromuscular blocking agents faster than Sugammadex and reverses the effects of benzylisoquinolines, without altering the effects of succinylcholine. IARS Abstract presented in May 2014. Anesth Analg. 2014;118:S1–139 (abstract no. S-50). http://www.iars.org/assets/1/7/AM14_AbstractSupp_F.pdf .