Teoh Wendy H, Ledowski Thomas, Tseng Phillip S
Private Anaesthesia Practice, Wendy Teoh Pte. Ltd., Singapore; College of Anaesthesiologists, Singapore.
School of Medicine and Pharmacology, University of Western Australia, Perth, WA, Australia.
Anesthesiol Res Pract. 2016;2016:7284146. doi: 10.1155/2016/7284146. Epub 2016 Oct 13.
. This survey aimed to investigate the attitudes/practice pertaining the use, management, and monitoring of neuromuscular blockade amongst Singaporean anaesthetists. . All specialist accredited anaesthetists registered with the Singapore Medical Council were invited to complete an anonymous online survey. . The response rate was 39.5%. Neuromuscular monitoring (NM) was used routinely by only 13.1% despite the widespread availability of monitors. 82% stated residual NMB (RNMB) was a significant risk factor for patient outcome, but only 24% believed NMB monitoring should be compulsory in all paralyzed patients. 63.6% of anaesthetists estimated the risk of RNMB in their own institutions to be <5%. 63.1% always gave reversal. Neostigmine was predominantly used (85.1%), with 28.2% using sugammadex at least sometimes, citing unavailability and high costs. However, 83.8% believed in sugammadex's benefits for patients' safety and >50% said such benefits may be able to offset the associated costs. . There is a significant need for reeducation about RNMB, studies on local RNMB incidences, and strengthening of current monitoring practices and guidelines. Strategies are discussed. As NM monitors appear widely available and reversal of NMB standard practice, it is hopeful that Singaporean anaesthetists will change and strive for evidence-based best clinical practice to enhance patient safety.
本调查旨在研究新加坡麻醉医生在神经肌肉阻滞的使用、管理及监测方面的态度和做法。邀请了所有在新加坡医学委员会注册的专科认可麻醉医生完成一项匿名在线调查。回复率为39.5%。尽管监测仪广泛可得,但仅13.1%的医生常规使用神经肌肉监测(NM)。82%的医生表示残余神经肌肉阻滞(RNMB)是影响患者预后的重要风险因素,但只有24%的医生认为所有麻痹患者都应强制进行神经肌肉阻滞监测。63.6%的麻醉医生估计其所在机构中RNMB的风险低于5%。63.1%的医生总是进行逆转。主要使用新斯的明(85.1%),28.2%的医生至少有时使用舒更葡糖,原因是无法获得且成本高。然而,83.8%的医生相信舒更葡糖对患者安全有益,超过50%的医生表示这些益处或许能够抵消相关成本。迫切需要对RNMB进行再教育、开展关于当地RNMB发生率的研究,并加强当前的监测做法和指南。文中讨论了相关策略。鉴于NM监测仪似乎广泛可得且神经肌肉阻滞逆转是标准做法,希望新加坡麻醉医生能够做出改变,努力追求基于证据的最佳临床实践以提高患者安全。