Postoperative Residual Paralysis—What it is, How to Recognize it, and How to Treat it: Evidence-based Summary

Administration of sugammadex reversal appears to decrease the incidence of postoperative residual paralysis more efficiently than neostigmine with glycopyrrolate administration. However, it does not necessarily decrease the overall incidence of pulmonary complications compared to neostigmine with glycopyrrolate. Evidence emphasizes that the most important steps to reduce postoperative residual paralysis are to administer a reversal agent even if spontaneous muscle recovery has been achieved and to monitor a patient's train-of-four ratio with quantitative, not qualitative, neuromuscular monitoring.