A survey of the current use of neuromuscular blocking drugs among the Middle Eastern anesthesiologists

Abstract

Background:This survey aimed to assess the extent of practice of the Middle Eastern anesthesiologists in the use of neuromuscular blocking agents (NMB) in 2012.Methods:We distributed an electronic survey among 577 members of the Triple-M Middle Eastern Yahoo anesthesia group, enquiring about their practice in the use of neuromuscular blocking agents. Questions concerned the routine first choice use of NMB, choice for tracheal intubation, the use of neuromuscular monitoring (NMT), type of NMB used in difficult airway, frequency of using suxamethonium, cisatracurium, rocuronium and sugammadex, observed side effects of rocuronium, residual curarization, and the reversal of residual curarization of rocuronium.Results:A total of 71 responses from 22 Middle Eastern institutions were collected. Most of the Middle Eastern anesthesiologists were using cisatracurium and rocuronium frequently for tracheal intubation (39% and 35%, respectively). From the respondents, 2/3 were using suxamethonium for tracheal intubation in difficult airway, 1/3 were using rocuronium routinely and 17% have observed hypersensitivity reactions to rocuronium, 54% reported residual curarization from rocuronium, 78% were routinely using neostigmine to reverse the rocuronium, 21% used sugammadex occasionally, and 35% were using NMT routinely during the use of NMB.Conclusions:We believe that more could be done to increase the awareness of the Middle Eastern anesthesiologists about the high incidence of PROC (>20%) and the need for routine monitoring of neuromuscular function. This could be accomplished with by developing formal training programs and providing official guidelines.

REVersal of nEuromusculAr bLocking Agents in Patients Undergoing General Anaesthesia (REVEAL Study)

“…National and international guidelines recommend neuromuscular monitoring during surgery, specifically at the end of the surgery before extubation [ 5 , 6 ]. Increased awareness of current guidelines [ 6 , 11 ] on NMT monitoring [ 12 ] and total decurarization may explain the rise in NMBA reversal use [ 13 ]. On the other hand, this may also be attributed to the emergence of sugammadex, which has a superior safety profile compared to previous anticholinergic drugs [ 14 , 15 ].…”

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

“…Eldawlatly and El-Tahan [7] reported the use of neostigmine was 78%. In a study conducted by Naguib et al [8] in Eu- paralysis.…”

Cyclodextrins: Emerging Medicines of the New Millennium

“…A simple solution is to use a cyclodextrin that removes the neuromuscular blocking agent from its site of action and renders it inactive by entrapping it in its cavity. For this, rocuronium bromide, one of the most used drugs for surgeries requiring tracheal intubation [97], was chosen as model drug and a γ-CD derivative was designed for maximal inclusion affinity. Of the three native CDs, γ-CD has the best suited inner diameter to include rocuronium bromide, a bulky steroidal guest.…”