Circulation 84,122 • Volume 23, No. 2 • Summer 2008   Issue PDF

Newsletter Readers Invited to Participate in Survey on Residual Weakness in PACU

Mohamed Naguib; Aaron Kopman; Cynthia Lien; Jennifer M. Hunter; Sorin J. Brull

Newsletter Readers Invited to Participate in Survey on Residual Weakness in PACU

To the Editor

Residual muscle weakness in the Post-Anesthesia Care Unit (PACU) secondary to intraoperatively administered nondepolarizing relaxants is much more common than most clinicians appreciate, and represents a potentially significant public health and patient safety issue. Recent surveys of clinical practices in Europe suggest that muscle relaxants are often administered without proper monitoring, and recent US publications continue to report significant morbidity associated with under-appreciated residual neuromuscular weakness.

If the incidence of postoperative residual weakness is to be reduced significantly, we need a better understanding of the current practices with nondepolarizing relaxants among clinicians. Surveys in Denmark, Germany, the United Kingdom, and Mexico have suggested that only 43%, 28%, 10%, and 2% of clinicians, respectively, routinely use neuromuscular monitors of any kind. No comparable study of clinical practice in North America has ever been undertaken.

Repeated editorials suggesting proper drug management and intraoperative monitoring have been largely ignored. The standard of care suggested by experts in the field regarding relaxant administration and the need for monitoring thus appear to be at variance with actual clinical practice. The extent to which this is true in the United States is currently unknown.

It is our objective to survey and compare clinical practices associated with the use of neuromuscular blocking drugs and neuromuscular monitoring among anesthesia practitioners in the United States and the European Union. At a time when major changes appear imminent in the way we think about and administer neuromuscular blocking drugs, we believe that a better understanding of actual clinical attitudes and practices is timely.

Thus, we kindly request your help in examining this matter, and invite all readers of the Newsletter to anonymously answer a brief series of questions on a website:

This study is not sponsored by a society, nor does it have any commercial affiliation. We have also secured our institutional approvals for this survey.

Many thanks for your time and help.

Mohamed Naguib
Aaron Kopman
Cynthia Lien
Jennifer M. Hunter
Sorin J. Brull