Audit of peripheral neuromuscular stimulators at the hospitals staffed by the Department of Anaesthesia and Perioperative Medicine at the University of Cape Town

Abstract

The first muscle relaxant, d-tubocurarine, was introduced into anaesthetic practice in 1942 by Harold Griffith.1 As early as 1954, it was noted that patients who had received d-tubocurarine had a six-fold higher mortality rate than patients who had not received the drug.2 Inadequate reversal of skeletal muscle paralysis at the end of anaesthesia has been described as postoperative residual curarization (PORC). In 1958, the use of a nerve stimulator to monitor the action of muscle relaxants was suggested,3 but for many years thereafter only clinical parameters were used to infer the absence of clinically significant PORC in the recovery area, including: Head lift more than 5 seconds, tongue protrusion, vital capacity > 15 ml/kg4 and hand grip strength.5