Survey on neuromuscular management.

Sir,

We would like to report the finding of the first electronic survey on the current practices in neuromuscular monitoring (NM) in UK. Postoperative residual curarization (PORC) is an underestimated postoperative complication, especially among less experienced anesthetists.[12] The incidence of PORC is estimated to be about 45% or 39-64% with vecuronium, atracurium, and rocuronium. The incidence is higher with longer acting neuromuscular blockade agents and inpatients.[3] Residual postoperative curarization is associated with higher risk of hypoxemia, upper respiratory obstruction, hypercapnia, dysarthria, impaired pharyngeal reflexes, aspiration, and diplopia. The aim of the survey was to determine the knowledge and attitudes of clinician to NM. An Internet based survey was conducted among all anesthetic departments in UK. Survey question was E-mailed to all anesthetic departments. The questionnaire was designed to be completed in 10 min. The questionnaire contained 10 questions. The survey was available on line for 90 days. A reminder was sent at the 45 and 60 days.

There were a total of 602 respondents, 382 (63.6%) were consultants, 163 (27.1%) were trainees and 57 (9.5%) were doctors in nontraining post. Only 31.7% of all respondents used NM routinely in their day-to-day practice while 8.9% never use it. The main reasons for not using NM were the predictability of muscle relaxant by 255 (63.4%) respondents. 202 (50.2%) respondents considered clinical signs adequate. 91 (22.6%) respondents cited lack of adequate equipment.

There has been an improvement in the use of NM when compared to previous surveys.[4] The use of this monitoring is an exception rather than a routine practice. The evidence is overwhelming in favors of the use of quantitative NM to titrate the doses of muscle relaxants and reversal agents. This could minimize patient discomfort and side-effects associated incomplete reversal. The information gained from this survey regarding existing clinical attitudes, knowledge, and barriers to routine quantitative NM will be useful in finding ways to overcome these in the future. Issues such as lack of equipment and training should be addressed at the national land departmental levels.