Trends in the use of neuromuscular blocking agents, reversal agents and neuromuscular transmission monitoring: a single-centre retrospective cohort study
Authors' conclusion
Our data demonstrate that the implementation of NMT monitoring with automatic recording coincides with a gradual increase in the (documented) use of NMT monitoring and an increased use of sugammadex with a more precise dose.
Study context
- Population
- Surgeries requiring endotracheal intubation with an NMBA, large teaching hospital in the Netherlands, January 2015–December 2019of 22,000 randomly selected
- Participants
- 14,592 surgeries
- Outcome
- Patterns in use of neuromuscular blocking agents (NMBAs), NMT monitoring and factors associated with sugammadex use
Methodological detailssingle-centre, observational, electronic medical records, Integrated neuromuscular transmission (NMT) monitoring module with automatic recording introduced in 2017
- Single-centre
- Observational
- Electronic medical records
- Integrated NMT monitoring module with automatic recording introduced in 2017
Main finding
As reported in the abstract
Trends in NMBA, reversal and NMT monitoring use, 2015–2019
Rocuronium: spontaneous reversal decreased
86 to 81%
Rocuronium: sugammadex reversal increased
12 to 18%
Extubated in OR with neither documented NMT monitoring nor sugammadex reversal, decline
46 to 31%
Extubated in OR without documented TOFR ≥ 0.9, decrease
77 to 56%
Observational data: associations, not effects.
Further findings
Factors independently associated with sugammadex use
| OR (95% CI) | ||
|---|---|---|
| BMI > 30 kg/m² | 1.41 (1.24–1.60) | |
| ASA class 3 or 4 | 1.20 (1.07–1.34) | |
| Age > 60 years | 1.37 (1.23–1.53) | |
| Duration of surgery < 120 min | 3.01 (2.68–3.38) | |
| Emergency surgery | 1.83 (1.60–2.09) | |
| Laparoscopic surgery | 2.01 (1.71–2.36) | |
| Open abdominal/thoracic surgery | 1.56 (1.38–1.78) | |
| NMT monitoring used | 5.31 (4.63–6.08) | |
| Total dose of rocuronium | 1.99 (1.76–2.25) | |
| Use of inhalational anaestheticsInverse association | 0.88 (0.79–0.99) | |
| 0.10.31310Odds ratio (log scale) |
Original publication
Trends in the use of neuromuscular blocking agents, reversal agents and neuromuscular transmission monitoring: a single-centre retrospective cohort study. Perioper Med (Lond). Published 27 March 2024. doi:10.
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