Anesthesia Providers' Knowledge and Utilization of a Quantitative Monitor for Neuromuscular Function Recovery

Abstract

Anesthesia providers have the cardinal responsibility to ensure that patient safety is maintained throughout the perioperative period. Neuromuscular blocking drugs are frequently administered to patients during surgery. Residual weakness at the end of surgery can place patients at risk for critical respiratory events. There are several ways to monitor a patient for recovery of neuromuscular function. The definition of recovery is defined as a Train-of-four ratio greater than 0.9 and can only be assessed using a quantitative peripheral nerve stimulator. The aim of this project was to increase knowledge and utilization regarding the use of quantitative monitors to assess neuromuscular function. Train-of-four (TOF) is the most widely used means of nerve stimulation assessment by delivering four equal stimuli; a comparison is made of the four responses (Nagelhout, 2014). When partial paralysis is present a fade in response occurs from twitch one to twitch four; the difference in twitch response is used to calculate the train-of-four ratio (TOFR) (Nagelhout, 2014). Anesthesia providers (n = 80) at two student clinical rotation sites in Maricopa County Arizona were sent a pretest survey, educational presentation, and posttest survey to compare knowledge and attitudes, awareness of techniques, and practice habits regarding neuromuscular monitoring; the final number of respondents was 12. The results of this project concluded that most providers assess neuromuscular function using a conventional peripheral nerve stimulator (n = 11). After reviewing the educational presentation, most anesthesia providers agreed that postoperative residual paralysis/weakness is a problem (n = 10) and the best method to assess neuromuscular function recovery and to guide reversal agent administration is to use a quantitative nerve stimulator (n = 9). Many providers (n = 7) stated they were unlikely to change their practice and cited inadequate resources as a barrier (n = 9). In conclusion, quantitative monitoring for neuromuscular function recovery may feasibly become the new standard of care with further education and access to the resources necessary to accomplish that.