Register your interest for the future project of the ESAIC Neuromuscular Blockade Management Network (NMBM-Net) 

Neuromuscular blocking agents (NMBAs) form a pivotal drug category in daily perioperative care. NMBAs agents improve intubating conditions, reduce laryngeal morbidity, and facilitate surgery. Hence, appropriate dosing, monitoring & reversal are essential to mitigate postoperative residual paralysis (RP) and postoperative pulmonary complications (POPC). However, the incidence of RP and POPC remains unacceptably high. An incomplete understanding of the physiological consequences of residual paralysis, poor adoption of neuromuscular monitoring in routine clinical practice and missing basic pharmacological data for some patient populations (e.g. the oldest old, the very young and the morbidly obese) may explain the persistence of these postoperative complications. It is critical that neuromuscular monitoring devices fulfil all of the anaesthesia practitioners’ clinical requirements, are easy to operate, and provide reproducible physiologic responses. Moreover, the development of machine learning algorithms to improve the reliability of monitoring of NMBAs and the implementation of PK/PD models to allow a prediction of drug effects may contribute to correct decision-making and improve adherence to neuromuscular monitoring. 

The NMBM-Net Research Group has been established in order to address the aforementioned issues under the umbrella of the ESAIC’s outstanding infrastructure and network. The group has contributed to the coordinated effort of publishing recent guidelines on the perioperative management of Neuromuscular blockade.¹ These have coincided with the unplanned but fortunate concomitant publishing of the equivalent ASA guidelines on this topic.² Both guidelines concluded that based on the substantive evidence accumulated during the last century, quantitative neuromuscular monitoring remains the only reliable method to ensure adequate recovery from the adverse effects of NMBAs in the postoperative period. Nevertheless, daily practicality, logistical issues, and the reluctance of some practitioners to abandon old habits teach us that the adoption of quantitative monitoring is still suboptimal.  

In fact, data preceding the ESAIC guidelines showed that less than one-fifth of patients across Europe underwent quantitative neuromuscular monitoring during general anaesthesia.¹ Given the significant body of evidence on the preventable character of RP, its incidence should be near 0%, while it is still reported to hover between 20 and 60%.^1-2 

Despite the widespread commercial availability of quantitative neuromuscular monitors, ranging from standalone devices to anaesthesia workstation-specific modules, active use of these monitors is frequently not prioritised by clinicians. Although recent surveys have suggested factors such as usability as potential culprits, representative, multinational, and transcontinental interview-based data on this topic is lacking.³ 

In this vein, the NMNB-Net group is conducting an International Focus Group discussion on factors facilitating an increased adoption of neuromuscular monitoring. This discussion aims to gain more in-depth information on factors that could lead to an increase in the adoption of neuromuscular monitoring, taking into account different country-specific contexts. The ESAIC is now opening the registration of interest for this project. 

Do you want to help improve the global understanding of the neuromuscular monitoring reality in your country and help us translate it into effective perioperative practice changes? 

You can register your interest through this link  

Participation in the interview session will be acknowledged with contributorship in the final published article. 

Authors

• Hugo Nogueira Carvalho (MD, PhD) – Department of Anesthesiology and Critical Care , AZ Sint Jan Brugge. Department of Anesthesiology and Perioperative Medicine, Universitair Ziekenhuis Brussel. Vrije Universiteit Brussel (Research consultant).
• Thomas Fuchs-Buder (MD, PhD) – CHRU Nancy. Chef du pôle Bloc Opératoire. Departement d’anesthésie, réanimation & médecine périoperatoire.

References

1. Fuchs-Buder T, Romero CS, Lewald H, et al. Peri-operative management of neuromuscular blockade: A guideline from the European Society of Anaesthesiology and Intensive Care. Eur J Anaesthesiol 2023;40(2):82-94. 
2. Thilen SR, Weigel WA, Todd MM, et al. 2023 American Society of Anesthesiologists Practice Guidelines for Monitoring and Antagonism of Neuromuscular Blockade: A Report by the American Society of Anesthesiologists Task Force on Neuromuscular Blockade. Anesthesiology 2023;138(1):13-41. 
3. Carvalho H, Verdonck M, Brull SJ, et al. A survey on the availability, usage, and perception of neuromuscular monitors in Europe. Journal of Clinical Monitoring and Computing. 2023 Apr;37(2):549-58.