National survey on the use of neuromuscular blockers and reversal in adult, pediatric and pregnant patients.

Abstract

Introduction This study presents the findings of an Italian investiga- tion through SIAATIP - Italian Society of Anesthesia, Analgesia and Pediatric Intensive Care - aimed at gather- ing data on current anesthetic practices related to the use of neuromuscular blockers, their reversal agents, and neuromuscular monitoring in pediatric, adult, and preg- nant patients. The study focused on several key areas: the types of neuromuscular blockers used, the frequency of neuromuscular monitoring, the safe TOF Ratio values for assessing recovery from neuromuscular blockade, the useand side effects of reversal agents, and the incidence of postoperative residual curarization (PORC). Materials and methods A digital questionnaire was distributed through links, so- cial media, and word of mouth to specialist physicians and those in specialized training in Anesthesia, Intensive Care, and Pain Therapy across Italy. The questionnaire aimed to gather information about clinical practices re- lated to neuromuscular blockade, categorized by patient type (adult, pediatric, or pregnant). Respondents pro- vided details on the type of neuromuscular blocker used, neuromuscular monitoring methods and extubation pa- rameters, documentation practices, reversal agents and their side effects, and the incidence of postoperative re- sidual curarization (PORC). Data were collected from February 1, 2023, to March 19, 2024, anonymously. Responses were analyzed based on percentages and stratified by age, geographic location, and workplace type (public or private). Results While sugammadex is widely used across all patient groups, neuromuscular monitoring remains inconsistent, and residual neuromuscular blockade (PORC) continues to be a concern despite its use. Monitoring practices and adherence to guidelines like TOF values appear to be bet- ter in specialized training centers. Conclusions The study emphasizes the critical need for proper moni- toring and reversal practices with neuromuscular block- ers, as neglecting these can jeopardize patient safety. The findings underline the importance of aligning clinical practices with guidelines, especially in pediatric and pregnant populations, where specific competencies and considerations are necessary.

Keywords

• neuromuscular blockers; reversal agent for neuromuscu- lar blockade; neuromuscular blockade management; re- sidual neuromuscular blockade; neuromuscular monitor- ing systems; prnb; porc; anesthetic practice.