Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1016/j.bjane.2015.03.001
Brazilian Journal of Anesthesiology
Scientific Article

Use of neuromuscular blockers in Brazil

Uso de bloqueadores neuromusculares no Brasil

Giovani de Figueiredo Locks; Ismar Lima Cavalcanti; Nadia Maria Conceição Duarte; Rafael Martins da Cunha; Maria Cristina Simões de Almeida

http://dx.doi.org/10.1016/j.bjane.2015.03.001 Braz J Anesthesiol, vol.65, n5, p.319-325, 2015
PDF English
PDF Português
Downloads: 1
Views: 1062

Abstract

ABSTRACTThe objective of this study was to evaluate how Brazilian anesthesiologists are using neuromuscular blockers, focusing on how they establish the diagnosis of postoperative residual curarization and the incidence of complications associated with the use of neuromuscular blockers. A questionnaire was sent to anesthesiologists inviting them to participate in the study. The online data collection remained open from March 2012 to June 2013. During the study period, 1296 responses were collected. Rocuronium, atracurium, and cisatracurium were the main neuromuscular blockers used in cases of elective surgery. Succinylcholine and rocuronium were the main neuromuscular blockers used in cases of emergency surgery. Less than 15% of anesthesiologists reported the frequent use of neuromuscular function monitors. Only 18% of those involved in the study reported that all workplaces have such a monitor. Most respondents reported using only the clinical criteria to assess whether the patient is recovered from the muscle relaxant. Most respondents also reported always using some form of neuromuscular blockade reversal. The major complications attributed to neuromuscular blockers were residual curarization and prolonged blockade. Eighteen anesthesiologists reported death attributed to neuromuscular blockers. Residual or prolonged blockade is possibly recorded as a result of the high rate of using clinical criteria to diagnose whether the patient has recovered or not from motor block and, as a corollary, the poor use of neuromuscular transmission monitors in daily practice.

Keywords

Neuromuscular blockers, Research on health services, Neuromuscular monitoring

Resumo

RESUMOO objetivo desta pesquisa foi avaliar como os anestesiologistas brasileiros estão usando os bloqueadores neuromusculares (BNM), com foco na forma de estabelecer o diagnóstico da curarização residual pós-operatória e a incidência de complicações atribuídas ao uso de BNM. Um questionário foi enviado a anestesiologistas convidando-os a participar da pesquisa (tabela 1). A coleta online de dados permaneceu aberta de março de 2012 a junho de 2013. Durante o período de estudo foram coletadas 1.296 respostas. Rocurônio, atracúrio e cisatracúrio foram os principais bloqueadores neuromusculares usados em casos de cirurgia eletiva. Succinilcolina e rocurônio foram os principais BNM usados em casos de cirurgia de emergência. Menos de 15% dos anestesiologistas referiram que usam frequentemente monitores da função neuromuscular. Apenas 18% dos envolvidos no estudo referiram que todos os locais de trabalho têm tal monitor. A maioria dos entrevistados afirmou que usa somente o critério clínico para avaliar se o paciente está recuperado do relaxante. A maioria dos entrevistados também relatou que sempre usa algum tipo de reversão de bloqueio neuromuscular. As principais complicações atribuídas aos BNM foram curarização residual e bloqueio prolongado. Houve relato por 18 anestesiologistas de óbito atribuído a BNM. O bloqueio residual ou prolongado se registra, possivelmente, como consequência do alto índice do uso de critérios clínicos para diagnosticar se o paciente está recuperado ou não do bloqueio motor e, como um corolário, o baixo uso de monitores da transmissão neuromuscular na prática diária.

Palavras-chave

Bloqueadores neuromusculares, Pesquisas sobre serviços de saúde, Monitoração neuromuscular

References

Berg H, Roed J, Viby-Mogensen J,. Residual neuromuscular block is a risk factor for postoperative pulmonary complications. A prospective, randomised, and blinded study of postopera- tive pulmonary complications after atracurium, vecuronium and pancuronium. Acta Anaesthesiol Scand. 1997;41:1095-103.

Mathias LA, da ST, de Bernardis RCG. Postoperative residual paralysis. Rev Bras Anestesiol. 2012;62:439-50.

Warner MA. Perioperative mortality: intraoperative anesthetic management matters. Anesthesiology. 2005;102:251-2.

Brull SJ, Naguib M, Miller RD. Residual neuromuscular block: rediscovering the obvious. Anesth Analg. 2008;107:11-4.

Eikermann M, Vogt FM, Herbstreit F,. The predisposition to inspiratory upper airway collapse during partial neuromuscular blockade. Am J Respir Crit Care Med. 2007;175:9-15.

Eriksson LI, Sato M, Severinghaus JW. Effect of a vecuronium- induced partial neuromuscular block on hypoxic ventilatory response. Anesthesiology. 1993;78:693-9.

Murphy GS, Brull SJ. Residual neuromuscular block: lessons unlearned. Part I: Definitions, incidence, and adverse physi- ologic effects of residual neuromuscular block. Anesth Analg. 2010;111:120-8.

Fuchs-Buder T, Claudius C, Skovgaard LT,. Good clinical research practice in pharmacodynamic studies of neuromuscular blocking agents II: the Stockholm revision. Acta Anaesthesiol Scand. 2007;51:789-808.

Eikermann M, Groeben H, Hüsing J,. Accelerometry of adductor pollicis muscle recovery of predicts respiratory function from neuromuscular blockade. Anesthesiology. 2003;98:1333-7.

Mortensen CR, Berg H, el-Mahdy A,. Perioperative moni- toring of neuromuscular transmission using acceleromyography prevents residual neuromuscular block following pancuronium. Acta Anaesthesiol Scand. 1995;39:797-801.

Gätke MR, Viby-Mogensen J, Rosenstock C,. Postopera- tive muscle paralysis after rocuronium: less residual block when acceleromyography is used. Acta Anaesthesiol Scand. 2002;46:207-13.

Sorgenfrei IF, Viby-Mogensen J, Swiatek FA. Does evidence lead to a change in clinical practice? Danish anaesthetists' and nurse anesthetists' clinical practice and knowledge of postoperative residual curarization. Ugeskr Laeger. 2005;167:3878-82.

Fuchs-Buder T, Hofmockel R, Geldner G,. The use of neuro- muscular monitoring in Germany. Anaesthesist. 2003;52:522-6.

Grayling M, Sweeney BP. Recovery from neuromuscular block- ade: a survey of practice. Anaesthesia. 2007;62:806-9.

Almeida MCS. O uso de bloqueadores neuromusculares no Brasil. Rev Bras Anestesiol. 2004;54:850-64.

Naguib M, Kopman AF, Lien CA,. A survey of current management of neuromuscular block in the United States and Europe. Anesth Analg. 2010;111:110-9.

Phillips S, Stewart PA, Bilgin AB. A survey of the management of neuromuscular blockade monitoring in Australia and New Zealand. Anaesth Intensive Care. 2013;41:374-9.

Beny K, Piriou V, Dussart C,. Impact of sugammadex on neuromuscular blocking agents use: a multicentric, pharmaco- epidemiologic study in French university hospitals and military hospitals. Ann Fr Anesth Reanim. 2013;32:838-43.

Sadleir PHM, Clarke RC, Bunning DL,. Anaphylaxis to neuromuscular blocking drugs: incidence and cross-reactivity in Western Australia from 2002 to 2011. Br J Anaesth. 2013;110:981-7.

Mertes PM, Tajima K, Regnier- Kimmoun MA. Perioperative anaphylaxis. Med Clin North Am. 2010;94:761-89.

Dewachter P, Mouton-Faivre C, Emala CW. Anaphylaxis and anesthesia: controversies and new insights. Anesthesiology. 2009;111:1141-50.

Dong SW, Mertes PM, Petitpain N,. Hypersensitivity reac- tions during anesthesia. Results from the ninth French survey (2005-2007). Minerva Anestesiol. 2012;78:868-78.

Eldawlatly A, El- Tahan MR. A survey of the current use of neuromuscular blocking drugs among the Middle Eastern anes- thesiologists. Saudi J Anaesth. 2013;7:146-50.

Sørensen MK, Bretlau C, Gätke MR,. Rapid sequence induction and intubation with rocuronium-sugammadex com- pared with succinylcholine: a randomized trial. Br J Anaesth. 2012;108:682-9.

Baillard C. Incidence and complications of post operative resid- ual paralysis. Ann Fr Anesth Reanim. 2009;28(^s2):S41-5.

Kotake Y, Ochiai R, Suzuki T,. Reversal with sugammadex in the absence of monitoring did not preclude residual neuro- muscular block. Anesth Analg. 2013;117:345-51.

Di Marco P, Della Rocca G, Iannuccelli F,. Knowledge of residual curarization: an Italian survey. Acta Anaesthesiol Scand. 2010;54:307-12.

Fuchs-Buder T, Meistelman C. Monitoring of neuromuscular block and prevention of residual paralysis. Ann Fr Anesth Reanim. 2009;28(^s2):S46-50.

Esteves S, Martins M, Barros F,. Incidence of postopera- tive residual neuromuscular blockade in the postanaesthesia care unit: an observational multicentre study in Portugal. Eur J Anaesthesiol. 2013;30:243-9.

Kaan N, Kocaturk O, Kurt I,. The incidence of resid- ual neuromuscular blockade associated with single dose of intermediate-acting neuromuscular blocking drugs. Middle East J Anesthesiol. 2012;21:535-41.

Kumar GV, Nair AP, Murthy HS,. Residual neuromuscular blockade affects postoperative pulmonary function. Anesthesi- ology. 2012;117:1234-44.

Cedborg AIH, Sundman E, Bodén K,. Pharyngeal func- tion and breathing pattern during partial neuromuscular block in the elderly: effects on airway protection. Anesthesiology. 2014;120:312-25.

Mertes PM, Alla F, Tréchot P,. Anaphylaxis during anesthesia in France: an 8-year national survey. J Allergy Clin Immunol. 2011;128:366-73.

Chong YY, Caballero MR, Lukawska J,. Anaphylaxis dur- ing general anaesthesia: one-year survey from a British allergy clinic. Singap Med J. 2008;49:483-7.

Karanovi´c N, Carev M, Kardum G,. Succinylcholine use in adult anesthesia - a multinational questionnaire survey. Coll Antropol. 2011;35(^s1):183-90.

Abrishami A, Ho J, Wong J,. Sugammadex, a selec- tive reversal medication for preventing postoperative residual neuromuscular blockade. Cochrane database Syst Rev. 2009:CD007362.

Hopkins PM. Malignant hyperthermia: pharmacology of trigger- ing. Br J Anaesth. 2011;107:48-56.

Murphy GS, Szokol JW, Avram MJ,. Postoperative resid- ual neuromuscular blockade is associated with impaired clinical recovery. Anesth Analg. 2013;117:133-41.

Murphy GS, Szokol JW, Marymont JH,. Residual neuromuscular blockade and critical respiratory events in the postanesthesia care unit. Anesth Analg. 2008;107:130-7.

5dcdbb480e8825b303bf58f5 rba Articles
Links & Downloads
2352-2291 (Electronic) 0104-0014 (Printed)
Braz J Anesthesiol ©2024 All rights reserved.

Braz J Anesthesiol

Share this page
Page Sections