Quantitative neuromuscular monitoring during general anesthesia: a prospective clinical audit of adherence to international guidelines
Authors' conclusion
This audit demonstrates high but incomplete adherence to qNM monitoring standards. Non-adherence is clustered primarily in procedures lasting less than one hour and in ambulatory and obstetrical settings. Although equipment was universally available, factors beyond equipment availability appear to contribute to incomplete implementation. Additional research is required to better understand the reasons underlying monitoring omission. In the meantime, targeted educational strategies and reinforcement of evidence-based neuromuscular monitoring practices may further enhance perioperative patient safety.
Study context
- Population
- Adult patients receiving general anesthesia at a major Portuguese tertiary hospital, March to May 2025patients included
- Participants
- 329 patients
- Exposure
- Adherence to recommended quantitative neuromuscular (qNM) monitoring standards
- Outcome
- Patients receiving NMBAs
Methodological detailssingle tertiary hospital, five predefined weekdays, six operating or procedural areas
- Single tertiary hospital
- Five predefined weekdays
- Six operating or procedural areas
Main finding
As reported in the abstract
Received neuromuscular blocking agents (NMBAs), of 329 patients included
308
93.6%
Observational data: associations, not effects.
Further findings
Omission of quantitative neuromuscular monitoring
- Quantitative neuromuscular monitoring omitted despite universal device availability
- 13.0%
Monitoring use by setting and procedure duration
- Utilization lower in ambulatory and obstetrical settings and in procedures lasting less than one hour
- Increasing anesthesia duration associated with greater monitoring use in univariable analysis, not independent of clinical location
Reasons for omission
- Equipment-related limitations accounted for a small proportion of omissions
Original publication
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