Kosciuczuk Urszula, Dardzinska Agnieszka, Kasperczuk Anna, Dzienis Paweł, Tomaszuk Adam, Tarnowska Katarzyna, Rynkiewicz-Szczepanska Ewa, Kossakowska Agnieszka, Pryzmont Marta
Department of Anaesthesiology and Intensive Therapy, Medical University of Bialystok, Kilinskiego Street 1, 15-276 Bialystok, Poland.
Faculty of Biocybernetics and Biomedical Engineering, Bialystok University of Technology, 15-276 Bialystok, Poland.
J Clin Med. 2024 Mar 29;13(7):1976. doi: 10.3390/jcm13071976.
Neuromuscular blocking agents are a crucial pharmacological element of general anesthesia. Decades of observations and scientific studies have resulted in the identification of many risks associated with the uncontrolled use of neuromuscular blocking agents during general anesthesia or an incomplete reversal of neuromuscular blockade in the postoperative period. Residual relaxation and acute postoperative respiratory depression are the most serious consequences. Cyclic recommendations have been developed by anesthesiology societies from many European countries as well as from the United States and New Zealand. The newest recommendations from the American Society of Anesthesiologists and the European Society of Anesthesiology were published in 2023. These publications contain very detailed recommendations for monitoring the dosage of skeletal muscle relaxants in the different stages of anesthesia-induction, maintenance and recovery, and the postoperative period. Additionally, there are recommendations for various special situations (for example, rapid sequence induction) and patient populations (for example, those with organ failure, obesity, etc.). The guidelines also refer to pharmacological drugs for reversing the neuromuscular transmission blockade. Despite the development of several editions of recommendations for monitoring neuromuscular blockade, observational and survey data indicate that their practical implementation is very limited. The aim of this review was to present the professional, technical, and technological factors that limit the implementation of these recommendations in order to improve the implementation of the guidelines and increase the quality of anesthesiological procedures and perioperative safety.
神经肌肉阻滞剂是全身麻醉的关键药理学要素。数十年的观察和科学研究已确定了与全身麻醉期间不受控制地使用神经肌肉阻滞剂或术后神经肌肉阻滞未完全逆转相关的许多风险。残余肌松和术后急性呼吸抑制是最严重的后果。许多欧洲国家以及美国和新西兰的麻醉学会都制定了周期性建议。美国麻醉医师协会和欧洲麻醉学会的最新建议于2023年发布。这些出版物包含了在麻醉诱导、维持和恢复以及术后不同阶段监测骨骼肌松弛剂剂量的非常详细的建议。此外，还有针对各种特殊情况（例如快速顺序诱导）和患者群体（例如器官衰竭、肥胖等患者）的建议。该指南还涉及用于逆转神经肌肉传递阻滞的药物。尽管已经制定了多个版本的神经肌肉阻滞监测建议，但观察性和调查数据表明它们的实际实施非常有限。本综述的目的是介绍限制这些建议实施的专业、技术和工艺因素，以改进指南的实施并提高麻醉程序的质量和围手术期安全性。
