Please use this identifier to cite or link to this item: http://hdl.handle.net/10553/130588
Title: An educational intervention to reduce the incidence of postoperative residual curarisation: a cluster randomised crossover trial in patients undergoing general anaesthesia
Authors: 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 Saavedra, 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
UNESCO Clasification: 32 Ciencias médicas
3201 Ciencias clínicas
321303 Anestesiología
Keywords: Acetylcholinesterase inhibitor
Neuromuscular block
Neuromuscular monitoring
Postoperative residual curarisation
Sugammadex
Issue Date: 2023
Journal: British journal of anaesthesia 
Abstract: Background: The incidence of postoperative residual curarisation remains unacceptably high. We assessed whether an educational intervention on perioperative neuromuscular block management can reduce it. Methods: 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. Results: 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). Conclusions: 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. Clinical trial registration: NCT03128151.
URI: http://hdl.handle.net/10553/130588
ISSN: 0007-0912
DOI: 10.1016/j.bja.2023.02.031
Source: British journal of anaesthesia [ISSN 0007-0912], v. 131(3), p. 482-490 (Septiembre 2023)
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