American Society of Anesthesiologists issues new guidance for physicians

The American Society of Anesthesiologists has issued new guidance on the monitoring and reversal of neuromuscular blockade medication during general anesthesia in the peer-reviewed medical journal Anesthesiology. 

Neuromuscular blocking medications are often used after the administration of anesthesia to relax the muscles and insert a breathing tube. While these medications aid anesthesiologists, they can leave lingering effects, including residual paralysis. 

The new ASA guidelines are meant to reduce the likelihood of residual paralysis and quickly reverse muscle relaxation. 

Eight new ASA recommendations and guidelines on neuromuscular blocking medication: 

1. When medication is administered, do not just perform a clinical assessment alone. 

2. Quantitative monitoring is recommended over qualitative assessment. 

3. With quantitative monitoring, confirm a train-of-four ratio greater than or equal to 0.9. 

4. Use the adductor pollicis muscle for monitoring. 

5. Use eye muscles for neuromuscular monitoring. 

6. Use sugammadex over neostigmine to avoid residual neuromuscular blockade. 

7. Neostigmine can be used at a minimal depth. 

8. Without quantitative monitoring, 10 minutes elapse from antagonism to extubation. 

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