J. Ross Renew, M.D., is interested in neuromuscular blockade management during the perioperative period. Anesthesiologists routinely use neuromuscular blocking agents to achieve drug-induced paralysis during surgery. These drugs help improve surgical conditions and keep patients from inadvertently moving while they are asleep during the operation.
Unfortunately, many patients experience postoperative residual weakness from suboptimal management of neuromuscular blockade and this condition can lead to complications. Dr. Renew is interested in reversal agents that can restore neuromuscular function, as well as emerging monitors that can confirm that patients have adequately recovered from neuromuscular blockade.
- Quantitative neuromuscular monitoring. Dr. Renew conducts research on the latest technologies that objectively measure the level of neuromuscular blockade present in the perioperative period. These include devices that use electromyography, acceleromyography and kinemyography to provide quantitative data to clinicians.
- Sugammadex and reversal agents. Sugammadex is a novel reversal agent that restores neuromuscular function after neuromuscular blockade. This drug was approved for use in the United States in 2015, and Dr. Renew and his team are interested in determining this drug's impact on patient outcomes and delineating optimal use in various clinical settings.
- Changes in practice. Despite an abundance of literature demonstrating that quantitative neuromuscular monitoring is effective at reducing postoperative residual weakness, the anesthesia community remains reluctant to adopt such technologies. Dr. Renew and his team are trying to determine why such barriers to advance practice exist and develop strategies to overcome them.
- Outcomes related to postoperative weakness. Not every patient who develops postoperative residual weakness after neuromuscular blockade has a complication. Dr. Renew is trying to determine which patients may be at higher risk of developing complications so that anesthesia providers can be vigilant in taking appropriate precautions for vulnerable patients.
Significance to patient care
Postoperative residual weakness is an iatrogenic complication of inappropriate neuromuscular blockade management in the perioperative period. This issue has persisted as a significant patient safety threat for decades. Dr. Renew and his team are striving to determine what monitoring modalities can be used to help guide anesthesia providers in using optimal neuromuscular blockade without leaving patients with weakness.
Currently, only a few centers use quantitative monitoring during the perioperative period and Dr. Renew hopes to provide guidance and evidence-based updates to expand utilization and combat this persistent patient safety threat.