Evaluation of monitoring and reversal habits of neuromuscular blockade by anesthesiologists in Hungary An online-based survey of current practice

Introduction: The ongoing effect of neuromuscular blocking agents after emergence from anesthesia is called postoperative residual neuromuscular block, which may lead to serious complications. The reliable identification of residual blockade is based on quantitative neuromuscular monitoring. In 2016, a survey was conducted among Hungarian anesthesiologists on monitoring and reversal habits of neuromuscular blockade. Objective: Our aim was to reveal the changes in neuromuscular monitoring and reversal habits following last six years' education programs. Method: We created a 10 -point online questionnaire using Google Forms software, which was distributed to anesthesiologists through the Hungarian Society of Anesthesiology and Intensive Care. 7 questions were identical to the questions of the 2016 questionnaire, 1 question had an additional answer option and 2 new questions were added. Statistical analysis was performed using chi 2 -test. Results: The questionnaire was available from April 10, 2022 to December 31, 2022. A total of 132 responses were received. 69% of the respondents estimated a 0-5% occurrence of residual blockade, compared to 75.6% in 2016 (p = 0.253). 53.1% of the respondents used neuromuscular monitoring in 0-10% of cases, compared to 75.8% previously. The proportion of anesthesiologists who regularly and always use monitors increased from 8% to 20.8% (p = 0.0005). The rate of omitting reversal agents decreased (20% vs. 31.15%), and the rate of those who regularly or always administer reversal agents increased (56.2% vs. 38.54) (p = 0.017). Quantitative monitors are available in 82% of anesthesia departments, but only in 23% of them are those available in every workstation, which means no change. Conclusion: Anesthesiologists still underestimate the incidence of residual blockade. The rate of rarely and nonmonitoring anesthesiologists decreased, and the rate of regular monitor users increased. Besides, a positive tendency could be observed in reversal habits of neuromuscular blockade. The availability of quantitative neuromuscular monitors is still insufficient.