Recommendations on the use of deep neuromuscular blockade by anaesthesiologists and surgeons. AQUILES (Anestesia QUIrúrgica para Lograr Eficiencia y Seguridad) Consensus

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• 作者：C.L. Errando-Oyonarte^a ; ^{errando013@gmail.com} ; C. Moreno-Sanz^b ; P. Vila-Caral^c ; J.C. Ruiz de Adana-Belbel^d ; E. Vá ; zquez-Alonso^e ; J.M. Ramí ; rez-Rodrí ; guez^f ; G. Veiga-Ruiz^g ; E. Guasch-Aré ; valo^h ; J.I. Lora-Tamayo D&rsquo ; Ocó ; nⁱ
• 关键词：General anaesthesia ; General and digestive surgery ; Neuromuscular blockade ; Muscle relaxation ; Muscle relaxants ; Monitoring ; Methods ; Delphi
• 刊名：Revista Española de Anestesiología y Reanimación (English Edition)
• 出版年：2017
• 出版时间：February 2017
• 年：2017
• 卷：64
• 期：2
• 页码：95-104
• 全文大小：660 K
• 卷排序：64

文摘

Neuromuscular blockade enables airway management, ventilation and surgical procedures. However there is no national consensus on its routine clinical use. The objective was to establish the degree of agreement among anaesthesiologists and general surgeons on the clinical use of neuromuscular blockade in order to make recommendations to improve its use during surgical procedures.MethodsMultidisciplinary consensus study in Spain. Anaesthesiologists experts in neuromuscular blockade management (n = 65) and general surgeons (n = 36) were included. Delphi methodology was selected. A survey with 17 final questions developed by a dedicated scientific committee was designed. The experts answered the successive questions in two waves. The survey included questions on: type of surgery, type of patient, benefits/harm during and after surgery, impact of objective neuromuscular monitoring and use of reversal drugs, viability of a multidisciplinary and efficient approach to the whole surgical procedure, focusing on the level of neuromuscular blockade.ResultsFive recommendations were agreed: (1) deep neuromuscular blockade is very appropriate for abdominal surgery (degree of agreement 94.1%), (2) and in obese patients (76.2%); (3) deep neuromuscular blockade maintenance until end of surgery might be beneficial in terms of clinical aspects, such as immobility or better surgical access (86.1–72.3%); (4) quantitative monitoring and reversal drugs availability is recommended (89.1%); finally (5) anaesthesiologists/surgeons joint protocols are recommended.ConclusionsCollaboration among anaesthesiologists and surgeons has enabled some general recommendations to be established on deep neuromuscular blockade use during abdominal surgery.