Peri-operative management of neuromuscular blockade: A guideline from the European Society of Anaesthesiology and Intensive Care
Methodological detailsGRADE methodology, two-step Delphi process, 88 relevant clinical studies selected from 24 000 by stepwise approach
- GRADE methodology
- Two-step Delphi process
- 88 relevant clinical studies selected from 24 000 by stepwise approach
Recommendations
As issued by the authors
- 1A
R1 Use a muscle relaxant to facilitate tracheal intubation
- 1C
R2 Use muscle relaxants to reduce pharyngeal and/or laryngeal injury following endotracheal intubation
- 1B
R3 Use a fast-acting muscle relaxant for rapid sequence induction intubation (RSII), such as succinylcholine 1 mg kg −1 or rocuronium 0.9 to 1.2 mg kg −1
- 1B
R4 Deepen NMB if surgical conditions need to be improved
- 2C
R5 Insufficient evidence to recommend deep NMB in general to reduce postoperative pain or decrease the incidence of peri-operative complications
- 1B
R6 Use ulnar nerve stimulation and quantitative neuromuscular monitoring at the adductor pollicis muscle to exclude residual paralysis
- 1A
R7 Use sugammadex to antagonise deep, moderate and shallow NMB induced by aminosteroidal agents (rocuronium, vecuronium)
- 1C
R8 Advanced spontaneous recovery (TOF ratio >0.2) before starting neostigmine-based reversal; continue quantitative monitoring until a TOF ratio of more than 0.9 has been attained
Original publication
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