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Díaz-Cambronero, Óscar; Mazzinari, Guido; Errando, Carlos L.; Garutti, Ignacio; Gurumeta, Alfredo A.; Serrano, Ana B.; Esteve, Neus; Montañes, Maria V.; Neto, Ary S.; Hollmann, Markus W.; Schultz, Marcus J.; Argente Navarro, Maria P.; Pérez, María del Pino Heredia; Núñez, Victoria Carvajal; Linero, Inmaculada Benítez; Aparicio, María del Pilar García; Miguel González de la Mata, Alba María; Marín, Alejandro Martínez; Mora Fernández, Luis Carlos; Robles, Ana Ferrer; González, David Fabián; Gil, Marta Mariscal; Romero, Germán Gómez; Montero, Begoña Ayas; Alberola Estellés, María José; Jaén, Salomé Matoses; Ortolá, Carlos Ferrando; Vargas, Esther Romero; Jaramago, Julia Martín; Mataix, Javier Barrio; Gonzalez, Estefanía Martínez; Sanus, Alma Casasempere; Fas Vicent, María José; Ortega, Juan; Pallardó López, María Angeles; Chornet, María Rosselló; Hernández, Alicia Sánchez; García Belmonte, José Pedro; Marcelino Martín, Miguel Ángel; Rodríguez Domínguez, Montserrat Noelia; Becerra-Bolaños, Ángel; Trujillo-Morales, Héctor; Palacín, Rebeca Pascual; Bartolomé Pacheco, María José; Pérez, Osvaldo; Rabago, José Luis; Caral, Pere Vila; Fernández Cortes, Ana Isabel; Milán, Marta Caballero; García, Lourdes Pérez; Alsina, Carme Subirà; Grauwinkel, Cassandra Gimeno; López González, José Manuel; Jiménez Gómez, Bárbara María; Gasalla Cadórniga, Alvaro Manuel; González, Iván Areán; Gil Campelo, María Ángeles; Solores, Felix Lobato; Santiago, Ana Crespo; Ortíz, Alvaro Elicegui; García, Isabel Gómez; Perote, Lara Castellanos; Murillo, Miguel Miró; Rueda, Fernando Ramasco; Roca, Antonio Planas; Irujo, Javier Ariño; Elguezábal, Pedro de la Calle; Palacios, Raúl Villalba; Saavedra, Bárbara; Learte, Mar Establés; López, Sandra Gadín; González, Rosa Sanz; Melchor, Javier Ripollés; Hurtado, Eugenio Martínez; Abad-Motos, Ane; López, María Uribarri; Martínez, Cristina Miguel
British journal of anaesthesia : BJA, 09/2023, Letnik: 131, Številka: 3Journal Article
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.
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