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Quantitative Neuromuscular Monitoring in Clinical Practice: A Professional Practice Change Initiative.
Weigel, Wade A; Williams, Barbara L; Hanson, Neil A; Blackmore, C Craig; Johnson, Randy L; Nissen, Gary M; James, Andrew B; Strodtbeck, Wyndam M.
Afiliación
  • Weigel WA; Anesthesiology Department, Virginia Mason Medical Center, Seattle, Washington.
  • Williams BL; Center for Healthcare Improvement Science, Virginia Mason Medical Center, Seattle, Washington.
  • Hanson NA; Department of Anesthesiology, University of Minnesota Medical Center, Minneapolis, Minnesota.
  • Blackmore CC; Center for Healthcare Improvement Science, Virginia Mason Medical Center, Seattle, Washington.
  • Johnson RL; Anesthesiology Department, Virginia Mason Medical Center, Seattle, Washington.
  • Nissen GM; Anesthesiology Department, Virginia Mason Medical Center, Seattle, Washington.
  • James AB; Anesthesiology Department, Virginia Mason Medical Center, Seattle, Washington.
  • Strodtbeck WM; Anesthesiology Department, Virginia Mason Medical Center, Seattle, Washington.
Anesthesiology ; 136(6): 901-915, 2022 06 01.
Article en En | MEDLINE | ID: mdl-35188958
BACKGROUND: Residual neuromuscular blockade can be avoided with quantitative neuromuscular monitoring. The authors embarked on a professional practice initiative to attain documented train-of-four ratios greater than or equal to 0.90 in all patients for improved patient outcomes through reducing residual paralysis. METHODS: The authors utilized equipment trials, educational videos, quantitative monitors in all anesthetizing locations, and electronic clinical decision support with real-time alerts, and initiated an ongoing professional practice metric. This was a retrospective assessment (2016 to 2020) of train-of-four ratios greater than or equal to 0.9 that were documented before extubation. Anesthesia records were manually reviewed for neuromuscular blockade management details. Medical charts of surgical patients who received a neuromuscular blocking drug were electronically searched for patient characteristics and outcomes. RESULTS: From pre- to postimplementation, more patients were assigned American Society of Anesthesiologists Physical Status III to V, fewer were inpatients, the rocuronium average dose was higher, and more patients had a prereversal train-of-four count less than 4. Manually reviewed anesthesia records (n = 2,807) had 2 of 172 (1%) cases with documentation of train-of-four ratios greater than or equal to 0.90 in November 2016, which was fewer than the cases in December 2020 (250 of 269 [93%]). Postimplementation (February 1, 2020, to December 31, 2020), sugammadex (650 of 935 [70%]), neostigmine (195 of 935 [21%]), and no reversal (90 of 935 [10%]) were used to attain train-of-four ratios greater than or equal to 0.90 in 856 of 935 (92%) of patients. In the electronically searched medical charts (n = 20,181), postimplementation inpatients had shorter postanesthesia care unit lengths of stay (7% difference; median [in min] [25th, 75th interquartile range], 73 [55, 102] to 68 [49, 95]; P < 0.001), pulmonary complications were less (43% difference; 94 of 4,138 [2.3%] to 23 of 1,817 [1.3%]; P = 0.010; -1.0% difference [95% CI, -1.7 to -0.3%]), and hospital length of stay was shorter (median [in days] [25th, 75th], 3 [2, 5] to 2 [1, 4]; P < 0.001). CONCLUSIONS: In this professional practice initiative, documentation of train-of-four ratios greater than or equal to 0.90 occurred for 93% of patients in a busy clinical practice. Return-of-strength documentation is an intermediate outcome, and only one of many factors contributing to patient outcomes.
Asunto(s)

Texto completo: 1 Colección: 01-internacional Banco de datos: MEDLINE Asunto principal: Fármacos Neuromusculares no Despolarizantes / Bloqueo Neuromuscular Tipo de estudio: Observational_studies / Prognostic_studies Límite: Humans Idioma: En Revista: Anesthesiology Año: 2022 Tipo del documento: Article

Texto completo: 1 Colección: 01-internacional Banco de datos: MEDLINE Asunto principal: Fármacos Neuromusculares no Despolarizantes / Bloqueo Neuromuscular Tipo de estudio: Observational_studies / Prognostic_studies Límite: Humans Idioma: En Revista: Anesthesiology Año: 2022 Tipo del documento: Article