An educational intervention to reduce the incidence of postoperative residual curarisation: a cluster randomised crossover trial in patients undergoing general anaesthesia
1
Issued Date
2023-01-01
Resource Type
ISSN
00070912
eISSN
14716771
Scopus ID
2-s2.0-85153096406
Journal Title
British Journal of Anaesthesia
Rights Holder(s)
SCOPUS
Bibliographic Citation
British Journal of Anaesthesia (2023)
Suggested Citation
Díaz-Cambronero Ó., Mazzinari G., Errando C.L., Garutti I., Gurumeta A.A., Serrano A.B., Esteve N., Montañes M.V., Neto A.S., Hollmann M.W., Schultz M.J., Argente Navarro M.P., Pérez M.d.P.H., Núñez V.C., Linero I.B., Aparicio M.d.P.G., Miguel González de la Mata A.M., Marín A.M., Mora Fernández L.C., Robles A.F., González D.F., Gil M.M., Romero G.G., Montero B.A., Alberola Estellés M.J., Jaén S.M., Ortolá C.F., Vargas E.R., Jaramago J.M., Mataix J.B., Gonzalez E.M., Sanus A.C., Fas Vicent M.J., Ortega J., Pallardó López M.A., Chornet M.R., Hernández A.S., García Belmonte J.P., Marcelino Martín M.Á., Rodríguez Domínguez M.N., Becerra-Bolaños Á., Trujillo-Morales H., Palacín R.P., Bartolomé Pacheco M.J., Pérez O., Rabago J.L., Caral P.V., Fernández Cortes A.I., Milán M.C., García L.P., Alsina C.S., Grauwinkel C.G., López González J.M., Jiménez Gómez B.M., Gasalla Cadórniga A.M., González I.A., Gil Campelo M.Á., Solores F.L., Santiago A.C., Ortíz A.E., García I.G., Perote L.C., Murillo M.M., Rueda F.R., Roca A.P., Irujo J.A., Elguezábal P.d.l.C., Palacios R.V., Saavedra B., Learte M.E., López S.G., González R.S., Melchor J.R., Hurtado E.M., Abad-Motos A., López M.U., Martínez C.M. An educational intervention to reduce the incidence of postoperative residual curarisation: a cluster randomised crossover trial in patients undergoing general anaesthesia. British Journal of Anaesthesia (2023). doi:10.1016/j.bja.2023.02.031 Retrieved from: https://repository.li.mahidol.ac.th/handle/123456789/82503
Title
An educational intervention to reduce the incidence of postoperative residual curarisation: a cluster randomised crossover trial in patients undergoing general anaesthesia
Author(s)
Díaz-Cambronero Ó.
Mazzinari G.
Errando C.L.
Garutti I.
Gurumeta A.A.
Serrano A.B.
Esteve N.
Montañes M.V.
Neto A.S.
Hollmann M.W.
Schultz M.J.
Argente Navarro M.P.
Pérez M.d.P.H.
Núñez V.C.
Linero I.B.
Aparicio M.d.P.G.
Miguel González de la Mata A.M.
Marín A.M.
Mora Fernández L.C.
Robles A.F.
González D.F.
Gil M.M.
Romero G.G.
Montero B.A.
Alberola Estellés M.J.
Jaén S.M.
Ortolá C.F.
Vargas E.R.
Jaramago J.M.
Mataix J.B.
Gonzalez E.M.
Sanus A.C.
Fas Vicent M.J.
Ortega J.
Pallardó López M.A.
Chornet M.R.
Hernández A.S.
García Belmonte J.P.
Marcelino Martín M.Á.
Rodríguez Domínguez M.N.
Becerra-Bolaños Á.
Trujillo-Morales H.
Palacín R.P.
Bartolomé Pacheco M.J.
Pérez O.
Rabago J.L.
Caral P.V.
Fernández Cortes A.I.
Milán M.C.
García L.P.
Alsina C.S.
Grauwinkel C.G.
López González J.M.
Jiménez Gómez B.M.
Gasalla Cadórniga A.M.
González I.A.
Gil Campelo M.Á.
Solores F.L.
Santiago A.C.
Ortíz A.E.
García I.G.
Perote L.C.
Murillo M.M.
Rueda F.R.
Roca A.P.
Irujo J.A.
Elguezábal P.d.l.C.
Palacios R.V.
Saavedra B.
Learte M.E.
López S.G.
González R.S.
Melchor J.R.
Hurtado E.M.
Abad-Motos A.
López M.U.
Martínez C.M.
Mazzinari G.
Errando C.L.
Garutti I.
Gurumeta A.A.
Serrano A.B.
Esteve N.
Montañes M.V.
Neto A.S.
Hollmann M.W.
Schultz M.J.
Argente Navarro M.P.
Pérez M.d.P.H.
Núñez V.C.
Linero I.B.
Aparicio M.d.P.G.
Miguel González de la Mata A.M.
Marín A.M.
Mora Fernández L.C.
Robles A.F.
González D.F.
Gil M.M.
Romero G.G.
Montero B.A.
Alberola Estellés M.J.
Jaén S.M.
Ortolá C.F.
Vargas E.R.
Jaramago J.M.
Mataix J.B.
Gonzalez E.M.
Sanus A.C.
Fas Vicent M.J.
Ortega J.
Pallardó López M.A.
Chornet M.R.
Hernández A.S.
García Belmonte J.P.
Marcelino Martín M.Á.
Rodríguez Domínguez M.N.
Becerra-Bolaños Á.
Trujillo-Morales H.
Palacín R.P.
Bartolomé Pacheco M.J.
Pérez O.
Rabago J.L.
Caral P.V.
Fernández Cortes A.I.
Milán M.C.
García L.P.
Alsina C.S.
Grauwinkel C.G.
López González J.M.
Jiménez Gómez B.M.
Gasalla Cadórniga A.M.
González I.A.
Gil Campelo M.Á.
Solores F.L.
Santiago A.C.
Ortíz A.E.
García I.G.
Perote L.C.
Murillo M.M.
Rueda F.R.
Roca A.P.
Irujo J.A.
Elguezábal P.d.l.C.
Palacios R.V.
Saavedra B.
Learte M.E.
López S.G.
González R.S.
Melchor J.R.
Hurtado E.M.
Abad-Motos A.
López M.U.
Martínez C.M.
Author's Affiliation
Mahidol Oxford Tropical Medicine Research Unit
Hospital Universitario Infanta Leonor
Hospital General Universitario Gregorio Marañon
Hospital Universitari i Politècnic La Fe
Hospital Universitario Ramón y Cajal
Hospital Israelita Albert Einstein
Faculty of Medicine, Nursing and Health Sciences
Nuffield Department of Medicine
Hospital Can Misses
Hospital Universitario Son Espases
Amsterdam UMC
Hospital Universitario Infanta Leonor
Hospital General Universitario Gregorio Marañon
Hospital Universitari i Politècnic La Fe
Hospital Universitario Ramón y Cajal
Hospital Israelita Albert Einstein
Faculty of Medicine, Nursing and Health Sciences
Nuffield Department of Medicine
Hospital Can Misses
Hospital Universitario Son Espases
Amsterdam UMC
Other Contributor(s)
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.