Neuromuscular blockade during general anaesthesia in the Czech Republic 2010 – a one-day, prospective, observational survey
Authors:
Adamus Milan 1; Herold Ivan 2; Cvachovec Karel 3; Ševčík Pavel 4; Černý Vladimír 5,6
Authors place of work:
Klinika anesteziologie a resuscitace, Lékařská fakulta Univerzity Palackého v Olomouci, Fakultní nemocnice Olomouc
1; Anesteziologicko-resuscitační oddělení, Oblastní nemocnice Mladá Boleslav, a. s.
2; Klinika anesteziologie a resuscitace, Univerzita Karlova v Praze, 2. lékařská fakulta a IPVZ, Fakultní nemocnice Motol, Praha
3; Klinika anesteziologie, resuscitace a intenzivní medicíny, Lékařská fakulta Masarykovy univerzity Brno, Fakultní nemocnice Brno
4; Dalhousie University, Dept. of Anesthesia, Halifax, Nova Scotia, Canada
5; Klinika anesteziologie, resuscitace a intenzivní medicíny, Univerzita Karlova v Praze, Lékařská fakulta v Hradci Králové, Fakultní nemocnice Hradec Králové
6
Published in the journal:
Anest. intenziv. Med., 22, 2011, č. 2, s. 82-89
Category:
Anaesthesiology - Original Paper
Summary
Objective:
To obtain data about the use of neuromuscular blocking agents during general anaesthesia in the Czech Republic.
Design:
One-day, prevalence, questionnaire survey.
Setting:
All anaesthetic care providers that registered before the date of the study.
Materials and methods:
This survey was part of the Czech Anaesthesia Day 2010 study. All the patients whose anaesthetic care was provided by the registered anaesthetic departments and was commenced on June 1, 2010, from 7:00 to 24:00 were enrolled. Data of each patient were entered into a web-based questionnaire and information relevant to neuromuscular blockade was collected.
Results:
Total 2,252 patients were given general anaesthesia and neuromuscular blockade was used in 55.9% cases. Tracheal intubation for elective surgery was most often facilitated by a non-depolarizing agent (55.7%), and in emergency cases by suxamethonium (49.4%). Atracurium (43.1%), suxamethonium (31.2%) and rocuronium (24.4%) were the most frequently used agents. During day-case surgery, a neuromuscular blocking agent was used in 3% cases compared to 39.9% for in-patient surgery (p < 0.0001). To reverse the block, neostigmine was administered in 24.1% of patients and sugammadex was used in one patient.
The degree of the neuromuscular block was monitored in 5.1%. Patients with neuromuscular monitoring received neostigmine more often than those without monitoring.
Conclusion:
A neuromuscular blocking agent was used during the maintenance of more than 50% of the general anaesthesia cases; atracurium, suxamethonium and rocuronium were the most frequently used drugs. A reversal agent (neostigmine) was given to 24% patients. Monitoring of the block was rare (5%).
Keywords:
questionnaire survey – general anaesthesia – neuromuscular block – non-depolarizing neuromuscular blocking agent – suxamethonium – reversal – monitoring
Zdroje
1. Naguib, M., Kopman, A. F., Lien, C. A., Hunter, J. M., Lopez, A., Brull, S. J. A survey of current management of neuromuscular block in the United States and Europe. Anesth. Analg., 2010, 111, p. 110–119.
2. Adamus, M., Marek, O. Monitorování účinku kurarimimetik během anestezie – současný stav v České republice. Anest. neodkl. Péče, 2000, 11, p. 245–250.
3. Adamus, M., Gabrhelík, T., Marek, O., Koutná, J., Trenkler, Š. Svalová relaxace na ARO České republiky 2006 – dotazníková studie. Anest. intenziv. Med., 2007, 18, p. 73–84.
4. Herold, I. Svalová relaxancia v anesteziologii a intenzivní péči. 1. vydání. Praha: Maxdorf, 2004, 268 s. ISBN 80-7345-025-9.
5. Černý, V., Cvachovec, K., Ševčík, P. et al. Doba úvodu a zotavení z celkové anestezie – prospektivní studie. Anest. intenziv. Med., 2007, 20, p. 236–240.
6. Černý, V., Adamus, M., Cvachovec, K., Ševčík, P., Herold, I. Anestezie v České republice 2010 – jednodenní prospektivní observační dotazníková studie. Anest. intenziv. Med., 2011, 22, 1, s. 5–12.
7. http://www.csarim.cz
8. Adamus, M., Koutná, J., Žáčková, D. Pooperační reziduální kurarizace na dospávacím pokoji – cisatrakurium vs. rokuronium: prospektivní studie. Anest. intenziv. Med., 2007, 18, p. 30–34.
9. Murphy, G. S., Brull, S. J. Residual neuromuscular block: lessons unlearned. Part I: definitions, incidence, and adverse physiologic effects of residual neuromuscular block. Anesth. Analg., 2010, 111, p. 120–128.
10. Brull, S. J., Murphy, G. S. Residual neuromuscular block: lessons unlearned. Part II: methods to reduce the risk of residual weakness. Anesth. Analg., 2010, 111, p. 129–140.
11. Uppal, V., Fletcher, G., Kinsella, J. Comparison of the i-gel with the cuffed tracheal tube during pressure-controlled ventilation. Brit. J. Anaesth., 2009, 102, p. 264–268.
12. Teoh, W. H., Lee, K. M, Suhitharan, T., Yahaya, Z., Teo, M. M., Sia, A. T. Comparison of the LMA Supreme vs the i-gel™ in paralysed patients undergoing gynaecological laparoscopic surgery with controlled ventilation. Anaesthesia, 2010, 65, p. 1173–1179.
13. Cammu, G., De Witte, J., De Veylder, J., Byttebier, G., Vandeput, D., Foubert, L., Vandenbroucke, G., Deloof, T. Postoperative residual paralysis in outpatients versus inpatients. Anesth. Analg., 2006, 102, p. 426–429.
14. Debaene, B., Plaud, B., Dilly, M. P., Donati, F. Residual paralysis in the PACU after a single intubating dose of nondepolarizing muscle relaxant with an intermediate duration of action. Anesthesiology, 2003, 98, p. 1042–1048.
15. Kopman, A. F, Eikermann, M. Antagonism of non-depolarising neuromuscular block: current practice. Anaesthesia, 2009, 64, Suppl. 1, p. 22–30.
16. Miller, R. D., Ward, T. A. Monitoring and pharmacologic reversal of a nondepolarizing neuromuscular blockade should be routine. Anesth. Analg., 2010, 111, p. 3–5.
17. Caldwell, J. E. Clinical limitations of acetylcholinesterase antagonists. J. Crit. Care, 2009, 24, p. 21–28.
18. Viby-Mogensen, J., Claudius, C. Evidence-based management of neuromuscular block. Anesth. Analg., 2010, 111, p. 1–2.
19. Donati, F. Neuromuscular monitoring: what evidence do we need to be convinced? Anesth. Analg., 2010, 111, p. 6–8.
20. Adamus, M., Černý, V., Herold, I., Cvachovec, K., Ševčík, P. Doporučené postupy ČSARIM – Zásady bezpečného a účelného používání svalových relaxancií v anesteziologii. Anest. intenziv. Med., 2009, 20, p. 131.
21. Černý, V., Herold, I., Cvachovec, K., Ševčík, P., Adamus, M. Guidelines for Managing Neuromuscular Block: Not Only Czech Beer Deserves a Taste. Anesth. Analg., 2011, 112, p. 482.
Štítky
Anaesthesiology, Resuscitation and Inten Intensive Care MedicineČlánok vyšiel v časopise
Anaesthesiology and Intensive Care Medicine
2011 Číslo 2
Najčítanejšie v tomto čísle
- Summary of the most important changes in the Guidelines for cardiopulmonary resuscitation
- Perioperative haemodynamic optimization
- Potential impact of criminal charges and claims of inadequate health care on the physicians‘ performance
- Neuromuscular blockade during general anaesthesia in the Czech Republic 2010 – a one-day, prospective, observational survey