Knowledge of residual curarization: an Italian survey

Area of Science:

• Anesthesiology
• Pharmacology
• Patient Safety

Background:

• Neuromuscular blocking agents (NMBAs) are crucial in anesthesia, but their current usage patterns in Italy are not well-documented.
• Understanding monitoring practices for neuromuscular blockade recovery is essential for preventing post-operative complications.

Purpose of the Study:

• To survey Italian anesthesiologists on their methods for assessing neuromuscular blockade recovery.
• To determine the reliability of clinical tests versus quantitative monitoring (e.g., train-of-four ratio).
• To estimate the incidence of post-operative paralysis in Italian hospitals.

Main Methods:

• A questionnaire was distributed to Italian anesthesiologists at a national congress.
• Data were collected and stratified by anesthesiologist age and hospital surgical volume.
• Response rate was 88.7%, with 754 valid questionnaires.

Main Results:

• 73% of respondents exclusively used clinical tests (head lift, tongue protrusion, eye opening) to monitor neuromuscular blockade.
• Only 35% routinely used train-of-four (TOF) monitoring.
• A TOF ratio of 0.9 for extubation was reported by only 24% of anesthesiologists.

Conclusions:

• The majority of Italian anesthesiologists depend on subjective clinical assessments for neuromuscular blockade recovery.
• There is a significant lack of awareness regarding the limitations of clinical tests in detecting residual neuromuscular block.
• Increased adoption of quantitative monitoring is recommended for safer NMBA use and improved patient outcomes.