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An educational intervention to reduce the incidence of postoperative residual curarisation: a cluster randomised crossover trial in patients undergoing general anaesthesia

2023; Elsevier BV; Volume: 131; Issue: 3 Linguagem: Inglês

10.1016/j.bja.2023.02.031

1471-6771

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

Intensive Care Unit Cognitive Disorders

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.