From the Department of General Anesthesia, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland Clinic, Cleveland, Ohio.
Department of Anesthesiology and Perioperative Medicine, Mayo Clinic College of Medicine, Jacksonville, Florida.
Anesth Analg. 2019 Jun;128(6):1118-1126. doi: 10.1213/ANE.0000000000003714.
In patients who receive a nondepolarizing neuromuscular blocking drug (NMBD) during anesthesia, undetected postoperative residual neuromuscular block is a common occurrence that carries a risk of potentially serious adverse events, particularly postoperative pulmonary complications. There is abundant evidence that residual block can be prevented when real-time (quantitative) neuromuscular monitoring with measurement of the train-of-four ratio is used to guide NMBD administration and reversal. Nevertheless, a significant percentage of anesthesiologists fail to use quantitative devices or even conventional peripheral nerve stimulators routinely. Our hypothesis was that a contributing factor to the nonutilization of neuromuscular monitoring was anesthesiologists' overconfidence in their knowledge and ability to manage the use of NMBDs without such guidance.
We conducted an Internet-based multilingual survey among anesthesiologists worldwide. We asked respondents to answer 9 true/false questions related to the use of neuromuscular blocking drugs. Participants were also asked to rate their confidence in the accuracy of each of their answers on a scale of 50% (pure guess) to 100% (certain of answer).
Two thousand five hundred sixty persons accessed the website; of these, 1629 anesthesiologists from 80 countries completed the 9-question survey. The respondents correctly answered only 57% of the questions. In contrast, the mean confidence exhibited by the respondents was 84%, which was significantly greater than their accuracy. Of the 1629 respondents, 1496 (92%) were overconfident.
The anesthesiologists surveyed expressed overconfidence in their knowledge and ability to manage the use of NMBDs. This overconfidence may be partially responsible for the failure to adopt routine perioperative neuromuscular monitoring. When clinicians are highly confident in their knowledge about a procedure, they are less likely to modify their clinical practice or seek further guidance on its use.
在接受麻醉时使用非去极化神经肌肉阻断药物（NMBD）的患者中，术后残留神经肌肉阻滞未被发现是一种常见现象，存在潜在严重不良事件的风险，特别是术后肺部并发症。有大量证据表明，当使用实时（定量）神经肌肉监测来测量四串比来指导 NMBD 给药和逆转时，可以预防残留阻滞。然而，仍有相当一部分麻醉师未能常规使用定量设备，甚至常规使用外周神经刺激器。我们的假设是，未能使用神经肌肉监测的一个因素是麻醉师对其在没有此类指导的情况下管理 NMBD 使用的知识和能力过于自信。
我们在全球范围内进行了一项基于互联网的多语言调查，调查对象为麻醉师。我们要求受访者回答 9 个与 NMBD 使用相关的真/假问题。参与者还被要求在 50%（纯猜测）到 100%（答案确定）的范围内对每个答案的准确性进行评分。
2560 人访问了该网站；其中，来自 80 个国家的 1629 名麻醉师完成了 9 个问题的调查。受访者仅正确回答了 57%的问题。相比之下，受访者表现出的平均置信度为 84%，明显高于他们的准确性。在 1629 名受访者中，有 1496 名（92%）过于自信。
接受调查的麻醉师对其管理 NMBD 使用的知识和能力表示过度自信。这种过度自信可能是未能采用常规围手术期神经肌肉监测的部分原因。当临床医生对某项程序的知识非常有信心时，他们不太可能改变他们的临床实践，或寻求进一步的指导。
