Recurarization is a rebound phenomenon in neuromuscular blockade.
Criteria for recurarization:
(1) The patient has undergone general surgery with neuromuscular blockage.
(2) Following surgery, discontinuation and administration of reversing agent, the effects of neuromuscular blockade dissipate.
(3) Sometime later symptoms of neuromuscular blockade (muscle weakness, postoperative respiratory distress, etc) reappear.
The rebound in neuromuscular blockade may appear soon after surgery or it may be delayed.
Causes of recurarization:
(1) insufficient dose of the reversing agent (neostigmine, sugammadex, etc)
(2) long-acting neuromuscular blockade and short-acting reversing agent
(3) accidental readministration of the neuromuscular blocking agent (in IV lines, mislabeled syringe, etc)
(4) accumulation of or decrease in clearance of neuromuscular blocking agent
(5) conditions that alter the kinetics of blockade and reversal (respiratory acidosis, magnesium infusion, infusion of an aminoglycoside, etc)
Monitoring the patient for neuromuscular blockade reversal allows for early recognition. Failure to monitor can result in rapid patient deterioration.
