Department of Anaesthesiology, Hospital Universitario y Politécnico la Fe, Valencia, Spain; Perioperative Medicine Research Group, Hospital Universitario y Politécnico la Fe, Valencia, Spain.
Department of Anaesthesiology, Hospital Universitario y Politécnico la Fe, Valencia, Spain; Perioperative Medicine Research Group, Hospital Universitario y Politécnico la Fe, Valencia, Spain.
Br J Anaesth. 2023 Sep;131(3):482-490. doi: 10.1016/j.bja.2023.02.031. Epub 2023 Apr 20.
The incidence of postoperative residual curarisation remains unacceptably high. We assessed whether an educational intervention on perioperative neuromuscular block management can reduce it.
In this multicentre, cluster randomised crossover trial, centres were allocated to receive an educational intervention either in a first or a second period. The educational intervention consisted of a lecture about neuromuscular management key points, including quantitative neuromuscular monitoring and use of reversal agents. The lecture was streamed to allow repetition. Additionally, memory cards were distributed in each operating theatre. The primary outcome was postoperative residual curarisation in the PACU. Secondary outcomes were frequency of quantitative neuromuscular monitoring, use of reversal agents, and incidence of postoperative pulmonary complications during hospital stay. Measurements were performed before randomisation and after the first and the second period. The effect of the educational intervention was estimated using multivariable mixed effects logistic regression models.
We included 2314 subjects in 34 Spanish centres. Postoperative residual curarisation incidence was not affected by the educational intervention (odds ratio [OR] 0.90 [95% confidence interval {CI}: 0.51-1.58]; P=0.717 and 1.30 [0.73-2.30]; P=0.371] for first and second time-period interaction). The educational intervention increased the quantitative neuromuscular monitor usage (OR 2.04 [95% CI: 1.31-3.19]; P=0.002), the use of reversal agents was unchanged (OR 0.79 [95% CI: 0.50-1.26]; P=0.322), and the incidence of postoperative pulmonary complications decreased (OR 0.19 [95% CI: 0.10-0.35]; P<0.001).
An educational intervention on perioperative neuromuscular block management did not reduce the incidence of postoperative residual curarisation nor increase reversal, despite increased quantitative neuromuscular monitoring. Sugammadex reversal was associated with reduced postoperative residual curarisation. The educational intervention was associated with a decrease in postoperative pulmonary complications.
NCT03128151.
术后残余肌松仍然高得不可接受。我们评估了围手术期神经肌肉阻滞管理的教育干预是否可以降低这种情况。
在这项多中心、集群随机交叉试验中，中心被分配在第一或第二阶段接受教育干预。教育干预包括关于神经肌肉管理要点的讲座，包括定量神经肌肉监测和使用逆转剂。讲座被流式传输以允许重复。此外，在每个手术室分发记忆卡。主要结局是 PACU 中的术后残余肌松。次要结局是定量神经肌肉监测的频率、逆转剂的使用以及住院期间术后肺部并发症的发生率。在随机分组前和第一阶段和第二阶段后进行测量。使用多变量混合效应逻辑回归模型估计教育干预的效果。
我们纳入了 34 家西班牙中心的 2314 名受试者。术后残余肌松发生率不受教育干预影响（第一时间周期交互作用的比值比 [OR] 0.90 [95%置信区间 {CI}：0.51-1.58]；P=0.717 和第二时间周期交互作用的 OR 1.30 [0.73-2.30]；P=0.371）。教育干预增加了定量神经肌肉监测的使用（OR 2.04 [95% CI：1.31-3.19]；P=0.002），逆转剂的使用保持不变（OR 0.79 [95% CI：0.50-1.26]；P=0.322），术后肺部并发症的发生率降低（OR 0.19 [95% CI：0.10-0.35]；P<0.001）。
尽管增加了定量神经肌肉监测，但围手术期神经肌肉阻滞管理的教育干预并未降低术后残余肌松的发生率，也未增加逆转。舒更葡糖钠逆转与术后残余肌松减少相关。教育干预与术后肺部并发症减少相关。
NCT03128151。
