Patient Safety, Complications, and Mishaps in Anesthesia

What Rules of Thumb Do Clinicians Use to Decide Whether to Antagonize Nondepolarizing Neuromuscular Blocking Drugs?

Videira RLR, Vieira JE (Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo (HC-FMUSP), Brazil) Anesth Analg 113:1192-1196, 2011^§

Abstract

Background

In anesthesia practice, inadequate antagonism of neuromuscular blocking drugs (NMBD) may lead to frequent prevalence of residual neuromuscular block that is associated with morbidity and death. In this study we analyzed the clinical decision on antagonizing NMBD to generate hypotheses about barriers to the introduction of experts’ recommendations into clinical practice.

Methods

Sequential surveys were conducted among 108 clinical anesthesiologists to elicit the rules of thumb (heuristics) that support their decisions and provide a measurement of the confidence the clinicians have in their own decisions in comparison with their peers’ decisions.

Results

The 2 most frequently used heuristics for administering reversal were “the interval since the last NMBD dose was short” and “the breathing pattern is inadequate,” chosen by 73% and 71% of the clinicians, respectively. Clinicians considered that the prevalence of clinically significant residual block is higher in their colleagues’ practices than in their own practice (60% vs 16%, odds ratio = 7.8, 95% confidence interval, 3.8 to 16.2, P = 0.0001). The clinicians were less likely to use antagonists if >60 minutes had elapsed after a single dose of atracurium (0.5 mg/kg) (31%) in comparison with after rocuronium 0.6 mg/kg (53%) (P = 0.0035).

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