Neuromuscular Monitoring in Anesthesia

Dr. Ilkka Kalli, MD, PhD, MBA Editor-in-chief, Clinical Window Web Journal See the editor-in-chief working and his Curriculum Vitae

Dear Clinician,

In the new issue of the Clinical Window Web Journal the topic is neuromuscular monitoring, muscle relaxants and monitoring of neuromuscular block.

Particularly in pediatric patients, pharmacology of neuromuscular blocking agents and monitoring of drug response may be different from adults. Dr. Olli Meretoja (Helsinki University, Finland) has studies pediatric muscle relaxants for over a decade and has written for our readers about clinical use of muscle relaxants in children.

Pointing out the wide individual variation in response to all muscle relaxants, he reviews properties of muscle relaxants in pediatric practices, particularly in intubation or maintenance of surgery. Adequate monitoring of the neuromuscular block is an essential part of good clinical pediatric anesthesia practice.

Residual neuromuscular block may be harmful for a patient. As Dr. Cammu (OLV Clinic, Aalst, Belgium) points out, the only reliable method of preventing postoperative residual curarization is by utilizing a quantitative train-of-four evaluation. He has studied postoperative residual curarization with cisatracurium and rocuronium infusions. The current paper is based on his interesting Clinical Window presentation at the ESA congress in Nice (April 2002). Patients receiving a cisatracurium or rocuronium infusion have a high incidence of postoperative residual curarization if the block is not antagonized.

In his comprehensive case based educational article, Dr. Michael W. Lew, (City of Hope National Medical Center, Duarte, CA, USA) reviews the importance of spirometry and neuromuscular transmission (NMT) monitoring During laproscopic prostatectomy.

Last but not least, CWWJ has agreed with Elsevier about rights to publish a chapter on Neuromuscular block monitoring from the recent textbook Clinical Anesthesia Practice. That is copyrighted material, but our readers may study most of the textbook chapter on-line for their individual education.

Drs Robert Kirby, Nik Gravenstein and Emilio Lobato were editors for that textbook, as also Dr J.S. Gravenstein from whom I learned much on the years we both were editors for the Journal of Clinical Monitoring and Computing.

My article is a textbook chapter I wrote during my stay at the University of Florida in Gainesville. I want to thank all my colleagues and friends there for the great time and interesting discussions in their stimulating clinical and scientific environment.

Remember to visit our history of anesthesiology pages, we have added some more pictures there. In our podium section we have added a link to our previously published neuromuscular issue, which may be worth revisiting after you have studies this issue. The next issue will appear when the summer is over, and it will deal with maintenance of general anesthesia and entropy. Thereafter, in the middle of the autumn, there will be time again for a critical care issue. I wish our international readers all the best for the summer season.

Ilkka S. Kalli MD, PhD, MBA
Anesthesiologist, Editor-in-Chief
Clinical Window Web Journal

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Last updated: 1 July 2003Created
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