Guidelines for the Use of Neuromuscular Blocking Agents: A Clinical Update-Resource 2023 Annual Congress Merck PowerPoint

Resource 2023 Annual Congress Merck PowerPoint

Pdf Summary

This document provides an update on the guidelines for the use of neuromuscular blocking agents (NMBAs) during anesthesia. The authors disclose any potential conflicts of interest related to the content of the document. The learner outcomes of the document include discussing monitoring considerations for patients receiving NMBAs, describing updates to clinical guidelines on the administration of NMBAs during anesthesia, and discussing clinical applications of the new guidelines.<br /><br />The document goes on to discuss the monitoring of neuromuscular blockade when NMBAs are used, emphasizing the importance of assessing onset, depth of blockade, and recovery. Traditional methods of subjective clinical signs and nerve stimulators are still commonly used, but objective quantitative monitoring is becoming more accessible with new technology. The standard for readiness for extubation is a train of four ratio of 0.90.<br /><br />The document also explores the use of qualitative/subjective "twitch" monitors and quantitative/objective monitors for assessing neuromuscular blockade. It highlights that clinical signs alone are not reliable for assessing neuromuscular function and that objective monitoring is necessary.<br /><br />A case study is presented to illustrate the importance of proper monitoring and reversal of NMBAs. The patient experienced desaturation in the post-anesthesia care unit, which could have been detected earlier with appropriate monitoring. The use of reversal agents, such as neostigmine and sugammadex, is discussed, with sugammadex being recommended for deep, moderate, and shallow depths of NMB.<br /><br />The document concludes by discussing the incorporation of these guidelines into the practice of nurse anesthetists and the importance of developing facility-specific drug formularies and policies to ensure patient safety and improved outcomes.<br /><br />Overall, this document provides an update on the guidelines for the use of NMBAs during anesthesia, emphasizing the importance of proper monitoring and reversal to prevent residual neuromuscular blockade.

Keywords

neuromuscular blocking agents

anesthesia guidelines

monitoring considerations

clinical guidelines

neuromuscular blockade

quantitative monitoring

reversal agents

patient safety

improved outcomes

residual neuromuscular blockade