A survey of current concepts and practices related to use of neuromuscular blockers with antagonists and neuromuscular monitoring among Korean anesthesiologists

Abstract

The use of a neuromuscular blocker (NMB) is often re- Background: The goal of this nationwide survey was to investigate the current concepts and practices of the use of neuromuscular blockers and their antagonists, and the availability and clinical practice of neuromuscular monitoring in Korea.Methods: After obtaining approval from the board of directors of the Korean Society of Anesthesiologists, we distributed a questionnaire via email to anesthesiology specialists with registered email addresses. The survey included questions on the availability and daily use of neuromuscular blockers, their antagonists and neuromuscular monitoring. Results:The overall response rate was 23.7%. Rocuronium and pyridostigmine were preferred as neuromuscular blocker (92.9%) and antagonist (86.1%), respectively. Although most anesthesiologists recognized the detrimental effect of postoperative residual neuromuscular blockade (87.7%) and the importance of neuromuscular monitoring (76.3%), quantitative monitoring was available in only 51.2% of the hospitals. More than 75% of respondents still prefer to use clinical signs to evaluate the recovery from paralysis.Conclusions: Changes in attitude and behaviors that mimic neuromuscular monitoring in Korea will be possible by regular and repeated publicity and education. Furthermore, greater distribution of neuromuscular monitoring devices and routine clinical use of these devices are also required.

Evaluation of a Protocol for the Management of Maintenance and Reversal of Rocuronium Block Using Neostigmine or Sugammadex

“…Use of sugammadex is often restricted because of cost concerns, 10,12,13 and many anesthesia providers do not yet have access to quantitative monitoring. 7,9–11,31 Therefore, when providers were asked to follow the protocol in this study, they were practicing within constraints that are commonly encountered in contemporary anesthesia practice.…”

“…5 However, although it has been over 20 years since experts first recommended routine use of quantitative monitoring, 6 many anesthesiologists do not routinely use quantitative monitoring, which provides real-time TOFR measurements. 7–11…”

The potential risks of sugammadex

“…Therefore, it is better to avoid using more than the optimal dose of the drug. ers, many anesthesiologists do not perform neuromuscular monitoring [6]. Many anesthesiologists use routine dose empirically without estimating the depth of neuromuscular blockade at the time of administration of the reversal agent [6,34].…”

“…ers, many anesthesiologists do not perform neuromuscular monitoring [6]. Many anesthesiologists use routine dose empirically without estimating the depth of neuromuscular blockade at the time of administration of the reversal agent [6,34]. Empirical dosing is likely to result in excessive or insufficient doses of sugammadex, both of which are harmful.…”

“…Sugammadex provides fast and safe recovery from neuromuscular blockade without major adverse effects, and its clinical use is increasing [6]. Most of the studies have emphasized the efficacy and safety of sugammadex, but some have also reported its potential risks.…”