Thomsen Jakob Louis Demant, Mathiesen Ole, Hägi-Pedersen Daniel, Skovgaard Lene Theil, Østergaard Doris, Engbaek Jens, Gätke Mona Ring
Department of Anesthesiology, Herlev Hospital, University of Copenhagen, Copenhagen, Denmark.
Department of Anesthesiology, Zealand University Hospital, Koege, Denmark.
JMIR Res Protoc. 2017 Oct 6;6(10):e192. doi: 10.2196/resprot.7527.
Muscle relaxants facilitate endotracheal intubation under general anesthesia and improve surgical conditions. Residual neuromuscular blockade occurs when the patient is still partially paralyzed when awakened after surgery. The condition is associated with subjective discomfort and an increased risk of respiratory complications. Use of an objective neuromuscular monitoring device may prevent residual block. Despite this, many anesthetists refrain from using the device. Efforts to increase the use of objective monitoring are time consuming and require the presence of expert personnel. A neuromuscular monitoring e-learning module might support consistent use of neuromuscular monitoring devices.
The aim of the study is to assess the effect of a neuromuscular monitoring e-learning module on anesthesia staff's use of objective neuromuscular monitoring and the incidence of residual neuromuscular blockade in surgical patients at 6 Danish teaching hospitals.
In this interrupted time series study, we are collecting data repeatedly, in consecutive 3-week periods, before and after the intervention, and we will analyze the effect using segmented regression analysis. Anesthesia departments in the Zealand Region of Denmark are included, and data from all patients receiving a muscle relaxant are collected from the anesthesia information management system MetaVision. We will assess the effect of the module on all levels of potential effect: staff's knowledge and skills, patient care practice, and patient outcomes. The primary outcome is use of neuromuscular monitoring in patients according to the type of muscle relaxant received. Secondary outcomes include last recorded train-of-four value, administration of reversal agents, and time to discharge from the postanesthesia care unit as well as a multiple-choice test to assess knowledge. The e-learning module was developed based on a needs assessment process, including focus group interviews, surveys, and expert opinions.
The e-learning module was implemented in 6 anesthesia departments on 21 November 2016. Currently, we are collecting postintervention data. The final dataset will include data from more than 10,000 anesthesia procedures. We expect to publish the results in late 2017 or early 2018.
With a dataset consisting of thousands of general anesthesia procedures, the INVERT study will assess whether an e-learning module can increase anesthetists' use of neuromuscular monitoring.
Clinicaltrials.gov NCT02925143; https://clinicaltrials.gov/ct2/show/NCT02925143 (Archived by WebCite® at http://www.webcitation.org/6s50iTV2x).
肌肉松弛剂有助于全身麻醉下的气管插管，并改善手术条件。术后患者苏醒时仍处于部分麻痹状态即会发生残余神经肌肉阻滞。这种情况会导致主观不适，并增加呼吸并发症的风险。使用客观的神经肌肉监测设备可能会预防残余阻滞。尽管如此，许多麻醉医生仍不愿使用该设备。增加客观监测使用的努力既耗时，又需要专家在场。一个神经肌肉监测电子学习模块可能有助于持续使用神经肌肉监测设备。
本研究旨在评估神经肌肉监测电子学习模块对丹麦6家教学医院麻醉工作人员使用客观神经肌肉监测的影响以及手术患者残余神经肌肉阻滞的发生率。
在这项中断时间序列研究中，我们在干预前后连续3周的时间段内反复收集数据，并将使用分段回归分析来分析效果。纳入丹麦西兰岛地区的麻醉科，并从麻醉信息管理系统MetaVision收集所有接受肌肉松弛剂患者的数据。我们将在所有潜在影响层面评估该模块的效果：工作人员的知识和技能、患者护理实践以及患者结局。主要结局是根据所接受的肌肉松弛剂类型对患者进行神经肌肉监测的情况。次要结局包括最后记录的四个成串刺激值、逆转剂的使用、从麻醉后护理单元出院的时间以及一项评估知识的多项选择题测试。该电子学习模块是基于需求评估过程开发的，包括焦点小组访谈、调查和专家意见。
该电子学习模块于2016年11月21日在6个麻醉科实施。目前，我们正在收集干预后的数据。最终数据集将包括来自10000多例麻醉手术的数据。我们预计在2017年末或2018年初公布结果。
通过包含数千例全身麻醉手术的数据集，INVERT研究将评估电子学习模块是否能增加麻醉医生对神经肌肉监测的使用。
Clinicaltrials.gov NCT02925143；https://clinicaltrials.gov/ct2/show/NCT02925143（由WebCite®存档于http://www.webcitation.org/6s50iTV2x）
