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[Reporting of muscle relaxant effects in anaesthesia files concerning visceral surgery - a observational and
A d'Hollander1, C Baillard, G Gehan
1Service d'anesthésiologie, hôpital universitaire Cantonal, Genève, Suisse. dhollanderalain@yahoo.fr
Objectives:
To report any item documenting the peroperative muscle relaxant effects management in anaesthesia files issued from visceral surgery processes.
Type Of Study:
Prospective, observational and multicenter.
Patients And Methods:
A single operator analysed 1453 files proposed by nine anaesthetists' teams. The items selected concerned three periods: induction/tracheal intubation, paralysis maintenance, tracheal extubation. Reporting of 40 categories of items was studied.
Results:
Items related to laryngoscopy and intubation conditions were observed in 43% (0-95) [general average (intercentres min-max)] and in 11% (0-97) of the files, respectively. At least one level of paralysis was reported in 23% (0-96) of the files. For the paralysis maintenance, documentation of an effect appeared in 53% (4-96) of the documents. Neuromuscular assessments preceding the tracheal extubation were retrieved in 43% (12-89) of the notes. Adductor pollicis was concerned for 30% (1-89) of these observations. Detection of level of spontaneous paralysis offset, satisfying to the local standard, appeared in 14% (3-19) of the documents. Pharmacological reversal was noted for 25% (4-67) of the patients; the assessment of the effects so produced was reported in 8% (0-58).
Conclusion:
In the studied collection, the traceability of the peranaesthetic curarization management appears variable on both qualitative and quantitative levels. The emergence of a dedicated guideline - defining the criteria for producing a good documentation of the muscle relaxant use - becomes necessary to secure these practices for all physicians using muscle relaxants.
Insights
Documentation of muscle relaxant effects in anesthesia files is inconsistent, highlighting a need for clear guidelines. This study reveals variable traceability in perianesthetic curarization management, impacting patient safety.
Area of Science:
- Anesthesiology and Perioperative Medicine
- Pharmacology
- Patient Safety
Context:
- Visceral surgery involves complex anesthetic management, including the use of neuromuscular blocking agents.
- Effective documentation of muscle relaxant effects is crucial for safe patient care and procedural success.
- Current anesthetic record-keeping practices exhibit variability in documenting perianesthetic curarization.
Purpose:
- To assess the completeness and quality of documentation regarding muscle relaxant effects in anesthesia records from visceral surgery.
- To identify specific areas of underreporting in the management of neuromuscular blockade during anesthesia.
- To evaluate the traceability of perianesthetic curarization management in surgical anesthesia files.
Summary:
- A multicenter, observational study analyzed 1453 anesthesia files from visceral surgery.
- Documentation rates for intubation conditions, paralysis levels, and neuromuscular assessments were evaluated across different anesthetic phases.
- Significant variability was found in reporting muscle relaxant use, effects, and reversal, with low rates for critical assessments like neuromuscular function monitoring.
Impact:
- The findings underscore a critical gap in the traceability of muscle relaxant management, potentially compromising patient safety.
- Highlights the necessity for standardized guidelines and improved documentation practices for neuromuscular blockade in anesthesia.
- Emphasizes the need for enhanced training and adherence to protocols to ensure consistent and accurate recording of muscle relaxant administration and reversal.
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