TY - JOUR
T1 - An educational intervention to reduce the incidence of postoperative residual curarisation
T2 - a cluster randomised crossover trial in patients undergoing general anaesthesia
AU - Díaz-Cambronero, Óscar
AU - Mazzinari, Guido
AU - Errando, Carlos L.
AU - Garutti, Ignacio
AU - Gurumeta, Alfredo A.
AU - Serrano, Ana B.
AU - Esteve, Neus
AU - Montañes, Maria V.
AU - Neto, Ary S.
AU - Hollmann, Markus W.
AU - Schultz, Marcus J.
AU - Argente Navarro, Maria P.
AU - Reducing the Incidence of Post Operative Residual Curarization Zero investigators
AU - Pérez, María del Pino Heredia
AU - Núñez, Victoria Carvajal
AU - Linero, Inmaculada Benítez
AU - Aparicio, María del Pilar García
AU - Miguel González de la Mata, Alba María
AU - Marín, Alejandro Martínez
AU - Mora Fernández, Luis Carlos
AU - Robles, Ana Ferrer
AU - González, David Fabián
AU - Gil, Marta Mariscal
AU - Romero, Germán G. mez
AU - Montero, Begoña Ayas
AU - Alberola Estellés, María José
AU - Jaén, Salomé Matoses
AU - Ortolá, Carlos Ferrando
AU - Vargas, Esther Romero
AU - Jaramago, Julia Martín
AU - Mataix, Javier Barrio
AU - Gonzalez, Estefanía Martínez
AU - Sanus, Alma Casasempere
AU - Fas Vicent, María José
AU - Ortega, Juan
AU - Pallardó López, María Angeles
AU - Chornet, María Rosselló
AU - Hernández, Alicia S. nchez
AU - García Belmonte, José Pedro
AU - Marcelino Martín, Miguel Ángel
AU - Rodríguez Domínguez, Montserrat Noelia
AU - Becerra-Bolaños, Ángel
AU - Trujillo-Morales, H. ctor
AU - Palacín, Rebeca Pascual
AU - Bartolomé Pacheco, María José
AU - Pérez, Osvaldo
AU - Rabago, José Luis
AU - Caral, Pere Vila
AU - Fernández Cortes, Ana Isabel
AU - Milán, Marta Caballero
AU - García, Lourdes P. rez
N1 - Funding Information: OD-C has received funding from MSD (Kenilworth, NJ, USA) for investigator-initiated clinical trials. The other authors declare that they have no conflicts of interest. Publisher Copyright: © 2023 British Journal of Anaesthesia
PY - 2023/9
Y1 - 2023/9
N2 - Background: The incidence of postoperative residual curarisation remains unacceptably high. We assessed whether an educational intervention on perioperative neuromuscular block management can reduce it. Methods: In this multicentre, cluster randomised crossover trial, centres were allocated to receive an educational intervention either in a first or a second period. The educational intervention consisted of a lecture about neuromuscular management key points, including quantitative neuromuscular monitoring and use of reversal agents. The lecture was streamed to allow repetition. Additionally, memory cards were distributed in each operating theatre. The primary outcome was postoperative residual curarisation in the PACU. Secondary outcomes were frequency of quantitative neuromuscular monitoring, use of reversal agents, and incidence of postoperative pulmonary complications during hospital stay. Measurements were performed before randomisation and after the first and the second period. The effect of the educational intervention was estimated using multivariable mixed effects logistic regression models. Results: We included 2314 subjects in 34 Spanish centres. Postoperative residual curarisation incidence was not affected by the educational intervention (odds ratio [OR] 0.90 [95% confidence interval {CI}: 0.51–1.58]; P=0.717 and 1.30 [0.73–2.30]; P=0.371] for first and second time-period interaction). The educational intervention increased the quantitative neuromuscular monitor usage (OR 2.04 [95% CI: 1.31–3.19]; P=0.002), the use of reversal agents was unchanged (OR 0.79 [95% CI: 0.50–1.26]; P=0.322), and the incidence of postoperative pulmonary complications decreased (OR 0.19 [95% CI: 0.10–0.35]; P<0.001). Conclusions: An educational intervention on perioperative neuromuscular block management did not reduce the incidence of postoperative residual curarisation nor increase reversal, despite increased quantitative neuromuscular monitoring. Sugammadex reversal was associated with reduced postoperative residual curarisation. The educational intervention was associated with a decrease in postoperative pulmonary complications. Clinical trial registration: NCT03128151.
AB - Background: The incidence of postoperative residual curarisation remains unacceptably high. We assessed whether an educational intervention on perioperative neuromuscular block management can reduce it. Methods: In this multicentre, cluster randomised crossover trial, centres were allocated to receive an educational intervention either in a first or a second period. The educational intervention consisted of a lecture about neuromuscular management key points, including quantitative neuromuscular monitoring and use of reversal agents. The lecture was streamed to allow repetition. Additionally, memory cards were distributed in each operating theatre. The primary outcome was postoperative residual curarisation in the PACU. Secondary outcomes were frequency of quantitative neuromuscular monitoring, use of reversal agents, and incidence of postoperative pulmonary complications during hospital stay. Measurements were performed before randomisation and after the first and the second period. The effect of the educational intervention was estimated using multivariable mixed effects logistic regression models. Results: We included 2314 subjects in 34 Spanish centres. Postoperative residual curarisation incidence was not affected by the educational intervention (odds ratio [OR] 0.90 [95% confidence interval {CI}: 0.51–1.58]; P=0.717 and 1.30 [0.73–2.30]; P=0.371] for first and second time-period interaction). The educational intervention increased the quantitative neuromuscular monitor usage (OR 2.04 [95% CI: 1.31–3.19]; P=0.002), the use of reversal agents was unchanged (OR 0.79 [95% CI: 0.50–1.26]; P=0.322), and the incidence of postoperative pulmonary complications decreased (OR 0.19 [95% CI: 0.10–0.35]; P<0.001). Conclusions: An educational intervention on perioperative neuromuscular block management did not reduce the incidence of postoperative residual curarisation nor increase reversal, despite increased quantitative neuromuscular monitoring. Sugammadex reversal was associated with reduced postoperative residual curarisation. The educational intervention was associated with a decrease in postoperative pulmonary complications. Clinical trial registration: NCT03128151.
KW - acetylcholinesterase inhibitor
KW - neuromuscular block
KW - neuromuscular monitoring
KW - postoperative residual curarisation
KW - sugammadex
UR - http://www.scopus.com/inward/record.url?scp=85153096406&partnerID=8YFLogxK
U2 - https://doi.org/10.1016/j.bja.2023.02.031
DO - https://doi.org/10.1016/j.bja.2023.02.031
M3 - Article
C2 - 37087332
SN - 0007-0912
VL - 131
SP - 482
EP - 490
JO - British Journal of Anaesthesia
JF - British Journal of Anaesthesia
IS - 3
ER -