Martin-Flores Manuel, Sakai Daniel M, Campoy Luis, Gleed Robin D
Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY, USA.
Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY, USA.
Vet Anaesth Analg. 2018 Jul;45(4):443-451. doi: 10.1016/j.vaa.2018.03.002. Epub 2018 Mar 23.
To analyze practice habits associated with the use, reversal and monitoring of nondepolarizing neuromuscular blocking agents (NMBAs) in dogs by different groups of veterinarians.
Online anonymous survey to veterinarians.
Data from 390 answered surveys.
A questionnaire was sent to e-mail list servers of the American College of Veterinary Anesthesia and Analgesia (ACVAA-list), Sociedad Española de Anestesia y Analgesia Veterinaria (SEEAV-list), Colégio Brasileiro de Anestesiologia Veterinária (Brazilian College of Veterinary Anesthesiology; CBAV-list) and American College of Veterinary Ophthalmologists (ACVO-list) to elicit information regarding use of NMBAs and reversal agents, monitoring techniques, criteria for redosing, reversing and assessing adequacy of recovery of neuromuscular function. Binomial logistic regression was used to test for association between responses and group of veterinarians in selected questions.
Veterinarians of the ACVO-list use NMBAs on a higher fraction of their caseload than other groups (all p < 0.0001). Subjective assessment (observation) of spontaneous movement, including spontaneous breathing, is the most common method for assessing neuromuscular function (43% of pooled responses); 18% of participants always reverse NMBAs, whereas 16% never reverse them. Restoration of neuromuscular function is assessed subjectively by 35% of respondents. Residual neuromuscular block is the most common concern regarding the use of NMBAs for all groups of veterinarians. Side effects of reversal agents (anticholinesterases) were of least concern for all groups.
While most veterinarians are concerned about residual neuromuscular block, relatively few steps are implemented to reduce the risks of this complication, such as routine use of quantitative neuromuscular monitoring or routine reversal of NMBAs. These results suggest a limitation in transferring information among groups of veterinarians, or in implementing techniques suggested by scientific research.
分析不同组别的兽医在犬类中使用、逆转和监测非去极化神经肌肉阻滞剂（NMBAs）的实践习惯。
对兽医进行在线匿名调查。
来自390份已回复调查问卷的数据。
向美国兽医麻醉与镇痛学院（ACVAA-list）、西班牙兽医麻醉与镇痛协会（SEEAV-list）、巴西兽医麻醉学院（CBAV-list）和美国兽医眼科医师学院（ACVO-list）的电子邮件列表服务器发送问卷，以获取有关NMBAs和逆转剂的使用、监测技术、再次给药标准、逆转以及评估神经肌肉功能恢复充分性的信息。使用二项逻辑回归来检验选定问题中回答与兽医组之间的关联。
ACVO-list的兽医在其病例量中使用NMBAs的比例高于其他组（所有p<0.0001）。对包括自主呼吸在内的自主运动进行主观评估（观察）是评估神经肌肉功能最常用的方法（汇总回答的43%）；18%的参与者总是逆转NMBAs，而16%的参与者从不逆转。35%的受访者通过主观评估来判断神经肌肉功能是否恢复。所有兽医组在使用NMBAs时最常见的担忧都是残余神经肌肉阻滞。所有组对逆转剂（抗胆碱酯酶）的副作用关注最少。
虽然大多数兽医担心残余神经肌肉阻滞，但为降低这种并发症风险所采取的措施相对较少，如常规使用定量神经肌肉监测或常规逆转NMBAs。这些结果表明，兽医群体之间在信息传递或实施科研建议的技术方面存在局限性。
