A Cross-Sectional survey on Knowledge, Attitude, and Practices of Neuromuscular Monitoring among Indian Anesthesiologists
Abstract
Background: The utility of Neuromuscular monitoring (NMT) has not been studied in Indian scenario till date. We did a survey to evaluate the knowledge, attitude, practices of NMT among Indian anesthesiologists.
Methods: A questionnaire-based google form was sent to 350 anesthesiologists over 3-months. Demographic data was collected in initial questions, followed by data on their concepts, practices, and knowledge of NMT and postoperative residual nerve block (PRNB). Data were descriptively analysed using frequencies and percentages. Descriptive statistical testing was done using software package IBM SPSS 23.
Results: 88.9% of participants reported the use of clinical assessment. Though majority used clinical parameters, they were well-versed about Train-of-Four criteria. 75.9% stated the use of objective NMT in < 25 % of patients. The reasons for not using objective monitoring were scarcity of neuromuscular monitors, non-familiarity, and complexity of monitors. In regards to PRNB, 79.6 % participants considered PRNB to be an important clinical issue. Although in their clinical practice they rarely encountered PRNB, 74% responded that routine NMT can decrease PRNB. The cross-tabulation table reflected that the use of objective tools (P= 0.014), knowledge about the essentiality of NMT (p=0.003), correctly stating PRNB as an important clinical issue (p=0.006), and their understanding about unreliability of clinical tests (p=0.001) showed significant improvement with increasing anesthesia experience.
Conclusion: Participants showed great understanding of clinical and qualitative tests but not of quantitative tests, with low rate of usage of objective NMT. A lacuna in understanding of quantitative parameters must be addressed considering high incidence of PRNB and lack of sensitivity of clinical parameters.
[2] Madsen MV, Staehr-Rye AK, G€atke MR, Claudius C. Neuromuscular blockade for optimising surgical conditions during abdominal and gynaecological surgery: a systematic review. Acta Anaesthesiol Scand. 2015; 59: 1–16.
[3] Kopman AF, Yee PS, Neuman GG. Relationship of the train-of-four fade ratio to clinical signs and symptoms of residual paralysis in awake volunteers. Anesthesiology. 1997; 86:765-71.
[4] Fortier LP, McKeen D, Turner K, de Médicis É, Warriner B, Jones PM, et al. The RECITE study: A Canadian Prospective, Multicenter Study of the Incidence and Severity of Residual Neuromuscular Blockade. Anesth Analg. 2015; 121(2): 366-72.
[5] Aytac I, Postaci A, Aytac B, Sacan O, Alay GH, Celik B, et al. Survey of postoperative residual curarization, acute respiratory events and approach of anesthesiologists. Braz J Anesthesiol. 2016; 66: 55-62.
[6] Brull SJ, Naguib M. What we know: precise measurement leads to patient comfort and safety. Anesthesiology. 2011; 115: 918- 20.
[7] Naguib M, Kopman AF, Ensor JE. Neuromuscular monitoring and postoperative residual curarisation: a meta-analysis. Br J Anaesth. 2007; 98: 302-16.
[8] Unterbuchner C, Blobner M, Pühringer F, Janda M, Bischoff S, Bein B, et al. Development of an algorithm using clinical tests to avoid the postoperative residual neuromuscular block. BMC Anesthesiol. 2017; 17: 101.
[9] Murphy GS. Neuromuscular Monitoring in the Perioperative Period. Anesth Analg. 2018; 126: 464-8.
[10] Drenck NE, Ueda N, Olsen NV, Engbaek J, Jensen E, Skovgaard LT, et al. Manual evaluation of residual curarization using double burst stimulation: a comparison with train-of-four. Anesthesiology. 1989; 70:578-81.
[11] Capron F, Fortier LP, Racine S, Donati F. Tactile fade detection with hand or wrist stimulation using train-of-four, double-burst stimulation, 50-hertz tetanus, 100-hertz tetanus, and acceleromyography. Anesth Analg. 2006; 102:1578-84.
[12] Apfelbaum JL, Silverstein JH, Chung FF, Connis RT, Fillmore RB, Hunt SE, et al. American Society of Anesthesiologists Task Force on Postanesthetic Care. Practice guidelines for postanesthetic care: an updated report by the American Society of Anesthesiologists Task Force on Postanesthetic Care. Anesthesiology. 2013; 118:291-307.
[13] Checketts MR, Alladi R, Ferguson K, Gemmell L, Handy JM, Klein AA, et al; Association of Anaesthetists of Great Britain and Ireland. Recommendations for standards of monitoring during anaesthesia and recovery 2015: association of Anaesthetists of Great Britain and Ireland. Anaesthesia. 2016; 71:85-93.
[14] Phillips S, Stewart PA, Bilgin AB. A survey of the management of neuromuscular blockade monitoring in Australia and New Zealand. Anaesth Intensive Care. 2013; 41(3): 374-9.
[15] Naguib M, Kopman AF, Lien CA, Hunter JM, Lopez A, Brull SJ. A survey of current management of neuromuscular block in the United States and Europe. Anesth Analg. 2010; 111: 110-9.
[16] Mencke T, Echternach M, Plinkert PK, Johann U, Afan N, Rensing H, et al. Does the timing of tracheal intubation based on neuromuscular monitoring decrease laryngeal injury? A randomized, prospective, controlled trial. Anesth Analg 2006;102: 306-12.
[17] Thomsen JL, Nielsen CV, Palmqvist DF, Gätke MR. Premature awakening and underuse of neuromuscular monitoring in a registry of patients with butyrylcholinesterase deficiency. Br J Anaesth. 2015; 115 (Suppl 1): i89-i94.
[18] Lin XF, Yong CYK, Mok MUS, Ruban P, Wong P. Survey of neuromuscular monitoring and assessment of postoperative residual neuromuscular block in a postoperative anaesthetic care unit. Singapore Med J. 2020; 61(11):591-7.
[19] Cammu G, De Witte J, De Veylder J, Byttebier G, Vandeput D, Foubert L, et al. Postoperative residual paralysis in outpatients versus inpatients. Anesth Analg. 2006; 102: 426-9.
[20] Pedersen T, Viby-Mogensen J, Bang U, Olsen NV, Jensen E, Engboek J. Does perioperative tactile evaluation of the train-of-four response influence the frequency of postoperative residual neuromuscular blockade? Anesthesiology. 1990; 73: 835-9.
[21] Rodney G, Raju PK, Ball DR. Not just monitoring; a strategy for managing neuromuscular blockade. Anaesthesia. 2015; 70: 1105-9.
[22] Indications of neuromuscular blockade in anaesthesia. Short text. Ann Fr Anesth Reanim. 2000; 19(Suppl 2): 352s-355s.
[23] Cerny V, Herold I, Cvachovec K, Sevcik P, Adamus M. Guidelines for managing neuromuscular block: not only Czech beer deserves a taste. Anesth Analg 2011; 112: 482.
[24] Australian and New Zealand College of Anaesthetists (ANZCA); Professional documents [Internet]. Melbourne: Australian and New Zealand College of Anaesthetists. 2015. [cited 2018 February 12]. Available from: http://www.anzca.edu.au/resources/ professional-documents.
[25] The Association of Anaesthetists of Great Britain & Ireland (AAGBI); Guidelines [Internet]. London, UK: The Association of Anaesthetists of Great Britain & Ireland. 2015. [cited 2018 February 9] Available from: https://www.aagbi.org publications/publications-guidelines/S/Z.
[26] Popat M, Mitchell V, Dravid R, Patel A, Swampillai C, Higgs A. Difficult Airway Society Guidelines for the management of tracheal extubation. Anaesthesia 2012; 67: 318-40.
[27] American Society of Anesthesiologists; Standards and Guidelines and Related Resources [Internet]. Schaumburg, IL: American Society of Anesthesiologists. 2016. [cited 2018 February 9] Available from: http://www.asahq.org/quality-and-practice management/standards-guidelines-and-related-resources/ standards-for-basic-anesthetic-monitoring.
[28] Baillard C, Clec’h C, Catineau J, Salhi F, Gehan G, Cupa M, et al. Postoperative residual neuromuscular block: a survey of management. Bri J Anesth. 2005;95(5):622–6.
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Issue | Vol 9 No 1 (2023): Winter | |
Section | Research Article(s) | |
DOI | https://doi.org/10.18502/aacc.v9i1.11939 | |
Keywords | ||
block Neuromuscular agents neuromuscular nondepolarizing survey methods design questionnaire awakening post anesthesia delayed. |
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