Faculty Collaboration Database

A survey of current management of neuromuscular block in the United States and Europe. Anesth Analg 2010 Jul;111(1):110-9

Date

11/17/2009

Pubmed ID

19910616

DOI

10.1213/ANE.0b013e3181c07428

Scopus ID

2-s2.0-77954684148 (requires institutional sign-in at Scopus site)   276 Citations

Abstract

BACKGROUND: Postoperative residual neuromuscular block is a frequent occurrence. Recent surveys of clinical practice in Europe suggest that neuromuscular blocking drugs are often administered without appropriate monitoring. No comparable survey has been undertaken in the United States (US). From this survey, we compared current clinical neuromuscular practice and attitudes between anesthesia practitioners in the US and Europe.

METHODS: We conducted an Internet-based survey among anesthesia practitioners in the US and Europe. The Anesthesia Patient Safety Foundation and the European Society of Anaesthesiology e-mailed all of their active members, inviting them to anonymously answer a series of questions on a dedicated Internet Protocol address-sensitive website. The survey was available online for 60 days. The chi(2) test and Fisher's exact test were used to compare clinical survey items between the 2 cohorts.

RESULTS: A total of 2636 completed surveys were received. Most respondents from the US (64.1%) and Europe (52.2%) estimated the incidence of clinically significant postoperative residual neuromuscular weakness to be <1% (P < 0.0001). Routine pharmacologic reversal was less common in Europe than in the US (18% vs 34.2%, respectively; P < 0.0001), and quantitative monitors were available to fewer clinicians in the US (22.7%) than in Europe (70.2%) (P < 0.0001). However, 19.3% of Europeans and 9.4% of Americans never use neuromuscular monitors. Most respondents reported that neither conventional nerve stimulators nor quantitative train-of-four monitors should be part of minimum monitoring standards.

CONCLUSIONS: Our results suggest a lack of agreement among anesthesia providers about the best way to monitor neuromuscular function. Efforts to improve awareness by developing formal training programs and/or publishing official guidelines on best practices to reduce the incidence of postoperative neuromuscular weakness and patient morbidity are warranted.

Author List

Naguib M, Kopman AF, Lien CA, Hunter JM, Lopez A, Brull SJ

Author

Cynthia A. Lien MD Chair, Professor in the Anesthesiology department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Attitude of Health Personnel
Data Interpretation, Statistical
Europe
Health Care Surveys
Health Knowledge, Attitudes, Practice
Humans
Internet
Monitoring, Physiologic
Neuromuscular Blockade
Neuromuscular Nondepolarizing Agents
Paralysis
Postoperative Complications
Public Health
Safety
Surveys and Questionnaires
United States