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Rivista di Anestesia, Rianimazione, Terapia Antalgica e Terapia Intensiva
Minerva Anestesiologica 2012 Luglio;78(7):767-73
Neuromuscular block in Italy: a survey of current management
Della Rocca G. 1, Iannuccelli F. 2, Pompei L. 1, Pietropaoli P. 2, Reale C. 2, Di Marco P. 2 ✉
1 Clinic of Anesthesia and Resuscitation, School of Specialization in Anesthesia and Resuscitation, Udine University Hospital, Udine, Italy;
2 Department of Anesthesiology, Critical Care and Pain Therapy, Policlinico Umberto I University Hospital, La Sapienza University, Rome, Italy
BACKGROUND: Little is known about current use of neuromuscular blocking agents by Italian anesthetists. This paper reports the results of a survey conducted to obtain information about current management of neuromuscular block in Italy.
METHODS: A questionnaire was given to Italian Anesthetists attending the 64nd National Congress of the Italian Society of Anesthesia, Intensive Care, Analgesia and Intensive Therapy S.I.A.A.R.T.I. (Parma, 13th-16th October 2010). Collected data were stratified by age, geographical location, and the total number of surgical procedures performed in the hospitals concerned.
RESULTS: One thousand four hundred forty patients correctly compiled questionnaires were collected. 50% of respondents used clinical tests to monitor the level of neuromuscular blockade. The main clinical tests cited for the evaluation were: keeping the head lifted up for 5 seconds, protruding the tongue and opening the eyes. Train-of-four was used by 50% of respondents on a routine basis. Only 33% of anesthetists reply that a train-of-four ratio of 90% or more is the safe level prior to extubation.
CONCLUSION: Clinical signs are used by most of the Italian anesthetists to assess the recovery from neuromuscular blockade. There is poor awareness about their inability to indicate even a significant degree of residual neuromuscular block. A more extensive use of quantitative instrumental monitoring is required for the more rational use of neuromuscular blocking agents.