Objective neuromuscular monitoring of neuromuscular blockade in Denmark: an online‐based survey of current practice

Abstract

In this survey, Danish anaesthetists frequently, in an international perspective, use objNMM, but the use is often associated with technical difficulties.

Clinical Practice Guideline for the Management of Neuromuscular Blockade: What Are the Recommendations in the USA and Other Countries?

“…The Danish general anesthesia guideline from 2017 states that a nerve stimulator should be used whenever a nondepolarizing muscle relaxant is administered [76]. Despite not calling for quantitative monitoring, Denmark has an advanced monitoring practice that involves quantitative monitoring [41,51,77]. A survey in 2017 showed that 58% of the 653 responding anesthesiologists always use objective monitoring and 86% in at least three quarter of their patients.…”

“…A survey in 2017 showed that 58% of the 653 responding anesthesiologists always use objective monitoring and 86% in at least three quarter of their patients. Nearly all (97%) of the respondents reported having access to objective monitors [41].…”

“…In a recent Danish survey, 75% of respondents reported regularly having difficulties with objective monitoring devices (mostly referring to acceleromyography-based devices). The most frequent problems were the fluctuating and unreliable train-offour values as well as error messages from the monitor [41]. Nevertheless, objective NMM has been shown to decrease the incidence of RNMB and postoperative respiratory complications [35,36].…”

“…This survey also revealed that 64.1% of American and 52.2% European anesthesiologists believed the incidence of RNMB is < 1% yet multiple large-scale, contemporary studies have demonstrated the incidence to be between 40 and 60% [5-7, 8••]). Perhaps as a result of extensive educational efforts [19,[56][57][58], more recent surveys [41,59] have shown an improvement in general knowledge about neuromuscular blockade management and larger willingness to monitor and administer reversal agents properly. However, such important practice updates have been gradual and slow.…”

A multicenter survey on the use of neuromuscular blockade in Greece. Does the real-world clinical practice indicate the necessity of guidelines?

“…Multiple surveys conducted worldwide indicate that neuromuscular blocking drugs and their antagonists are commonly administered without adequate rationalization and monitoring, leading to variable incidence of RNMB. Studies from the United States, Europe,[6] Australia and New Zealand,[78] Italy,[910] Denmark,[11] Morocco,[12] and Brazil[13] suggest that currently, only a small percentage of anesthesiologists monitor neuromuscular function in their clinical practice, even in special patient groups. In addition, the absence of internationally accepted clinical guidelines regarding neuromuscular blockade remains a major problem.…”