Table 5.
Reversal strategies
| Total (n=87) | PACU | P | ||||
|---|---|---|---|---|---|---|
| No (n=44) | Yes (n=43) | |||||
| When a nondepolarizing neuromuscular blocking drug has been used, do you always administer a reversal agent at the end of surgery? | ||||||
| No | 23 (26.44%) | 10 (22.73%) | 13 (30.23%) | 0.473 | ||
| Yes | 64 (73.56%) | 34 (77.27%) | 30 (69.77%) | |||
| I don’t know/no answer- | - | - | ||||
| If the answer to the above question was “No,” what is the percentage of cases not given a reversal agent? | ||||||
| 1%-25% | 81 (93.1%) | 43 (97.73%) | 38 (88.37%) | 0.142 | ||
| 26%-50% | 3 (3.45%) | 0 | 3 (6.98%) | |||
| 51%-75% | 3 (3.45%) | 1 (2.27%) | 2 (4.65%) | |||
| 76%-100% | - | - | - | |||
| If you choose not to administer a reversal agent, which of the following factors contributes to that decision? Choose all that apply | ||||||
| Time since the last dose of non-depolarizing neuromuscular blocking agent | 47 (79.66%) | 23 (82.14%) | 24 (77.42%) | 0.752 | ||
| Absence of fade when using a conventional nerve stimulator | 23 (38.98%) | 12 (42.86%) | 11 (35.48%) | 0.602 | ||
| Measurement of TOF ratio | 31 (52.54%) | 13 (46.43%) | 18 (58.06%) | 0.439 | ||
| Absence of clinical signs of weakness | 40 (67.8%) | 20 (71.43%) | 20 (64.52%) | 0.591 | ||
| Use of a specific nondepolarizing neuromuscular blocking drug | 24 (40.68%) | 10 (35.71%) | 14 (45.16%) | 0.597 | ||
| Other | (I always administer reversal) | |||||
| Do you think that the clinical signs, such as the ability to sustain a 5-s head lift, are reliable indicators of the adequacy of neuromuscular recovery? | ||||||
| Totally agree | 20 (22.99%) | 14 (31.82%) | 6 (13.95%) | 0.012* | ||
| Agree | 40 (45.98%) | 23 (52.27%) | 17 (39.53%) | |||
| Disagree | 19 (21.84%) | 4 (9.09%) | 15 (34.88%) | |||
| Totally disagree | 7 (8.05%) | 3 (6.82%) | 4 (9.3%) | |||
| I don’t know/no answer | 1 (1.15%) | 0 | 1 (2.33%) | |||
| Do you think that a sustained response to a 50 Hz tetanic stimulation reflects the adequacy of the recovery of the neuromuscular function? | ||||||
| Totally agree | 19 (21.84%) | 14 (31.82%) | 5 (11.63%) | 0.051 | ||
| Agree | 20 (22.99%) | 10 (22.73%) | 10 (23.26%) | |||
| Disagree | 19 (21.84%) | 5 (11.36%) | 14 (32.56%) | |||
| Totally disagree | 12 (13.79%) | 5 (11.36%) | 7 (16.28%) | |||
| I don’t know/no answer | 17 (19.54%) | 10 (22.73%) | 7 (16.28%) | |||
| In your department which of the following neuromuscular reversal agents are available? | ||||||
| Neostigmine | 87 (100%) | - | - | |||
| Sugammadex | 85 (97.75%) | 42 (95.45%) | 43 (100%) | 0.494 | ||
| When using rocuronium, how often do you administer the following? | ||||||
| Neostigmine | ||||||
| Never | 17 (19.54%) | 11 (25%) | 6 (13.95%) | 0.531 | ||
| Rarely | 29 (33.33%) | 15 (34.09%) | 14 (32.56%) | |||
| Often | 31 (35.63%) | 13 (29.55%) | 18 (41.86%) | |||
| Very often | 10 (11.49%) | 5 (11.36%) | 5 (11.63%) | |||
| Sugammadex | ||||||
| Never | 4 (4.6%) | 2 (4.55%) | 2 (4.65%) | 0.532 | ||
| Rarely | 21 (24.14%) | 9 (20.45%) | 12 (27.91%) | |||
| Often | 23 (26.44%) | 10 (22.73%) | 13 (30.23%) | |||
| Very often | 39 (44.83%) | 23 (52.27%) | 16 (37.21%) | |||
| When using neostigmine, how much time do you allow from time of administration of neostigmine to extubation? | ||||||
| <2 min | 14 (16.09%) | 9 (20.45%) | 5 (11.63%) | 0.716 | ||
| 3-5 min | 46 (52.87%) | 23 (52.27%) | 23 (53.4%) | |||
| 6-10 min | 22 (25.29%) | 10 (22.73%) | 12 (27.91%) | |||
| >10 min | 5 (5.75%) | 2 (4.55%) | 3 (6.98%) | |||
| At what TOF count do you think that neostigmine would lead to a rapid and reliable reversal? | ||||||
| 1-2 | 22 (25.29%) | 13 (29.55%) | 9 (20.93%) | 0.447 | ||
| 3-4 | 32 (36.78%) | 17 (38.64%) | 15 (34.88%) | |||
| Any response to neuromuscular stimulation | 0 | 0 | 0 | |||
| What matters is the TOF ratio (%) | 33 (37.93%) | 14 (31.82%) | 19 (44.19%) | |||
| What is the dose of neostigmine that you usually administer? | ||||||
| 2.5 mg | 66 (75.86%) | 35 (79.55%) | 31 (72.09%) | 0.857 | ||
| <0.05 mg/kg | 5 (5.75%) | 2 (4.55%) | 3 (6.98%) | |||
| 0.05 mg/kg | 10 (11.49%) | 4 (9.09%) | 6 (13.95%) | |||
| >0.05 mg/kg | 6 (6.9%) | 3 (6.82%) | 3 (6.98%) | |||
| When using antimuscarinic/anticholinergic drugs, do you have any concern regarding their potential adverse effects? | ||||||
| No | 10 (11.49%) | 7 (15.91%) | 3 (6.98%) | 0.314 | ||
| Yes | 77 (88.51%) | 37 (84.09%) | 40 (93.02%) | |||
| I don’t know/no answer | - | - | - | |||
| If yes, what are they? Choose all that apply (no vs yes) | ||||||
| Cardiovascular effects | 60 (82.19%) | 28 (82.35%) | 32 (82.05%) | 0.999 | ||
| Respiratory effects | 38 (52.05%) | 18 (52.94%) | 20 (51.28%) | 0.999 | ||
| Increased nausea and vomiting | 26 (35.62%) | 11 (32.35%) | 15 (38.46%) | 0.631 | ||
| Inadequate reversal of neuromuscular blockade | 38 (52.05%) | 17 (50%) | 21 (53.85%) | 0.816 | ||
| Other | Increase of respiratory secretions, anticholinergic syndrome in the elderly | |||||
| In your opinion, at what TOF count would sugammadex lead to a rapid and reliable reversal? | ||||||
| 0-2 | 31 (35.63%) | 19 (43.18%) | 12 (27.91%) | 0.342 | ||
| 3-4 | 9 (10.34%) | 4 (9.09%) | 5 (11.63%) | |||
| Any response to neuromuscular stimulation | 47 (54.02%) | 21 (47.73%) | 26 (60.47%) | |||
| What is the dose of sugammadex do you most commonly administer? | ||||||
| 1 mg/kg | 10 (11.49%) | 7 (15.91%) | 3 (6.98%) | 0.538 | ||
| 2 mg/kg | 36 (41.38%) | 16 (36.36%) | 20 (46.51%) | |||
| 4 mg/kg | 9 (10.34%) | 5 (11.36%) | 4 (9.3%) | |||
| 16 mg/kg | 0 | 0 | 0 | |||
| Depends on the time of the last dose of neuromuscular blocking agent | 15 (17.24%) | 9 (20.45%) | 6 (13.95%) | |||
| Dose depends on TOF ratio | 17 (19.54%) | 7 (15.91%) | 10 (23.26%) | |||
| In which of the following cases would you choose to use sugammadex? Select all that apply | ||||||
| In surgical cases of short duration | 45 (51.72%) | 24 (54.55%) | 21 (48.84%) | 0.67 | ||
| Patients with specific comorbidities (obesity, elderly, chronic respiratory disease) | 64 (73.56%) | 30 (68.18%) | 34 (79.07%) | 0.332 | ||
| Always when rocuronium is administered | 33 (37.93%) | 21 (47.73%) | 12 (27.91%) | 0.077 | ||
| Other | Emergency operations, operations during night shifts, ENT operations, pediatric surgeries (adenoidectomies), reversal of neuromuscular blockade by rocuronium at a dose >1.2 mg/kg for rapid sequence intubation, cases of difficult airway/intubation | |||||
| Do you have any concerns about the adverse effects associated with the administration of sugammadex? | ||||||
| No | 52 (59.77%) | 26 (59.09%) | 26 (60.47%) | 0.458 | ||
| Yes | 33 (37.93%) | 18 (40.91%) | 15 (34.88%) | |||
| I don’t know/no answer | 2 (2.3%) | 0 | 2 (4.65%) | |||
| What adverse effects associated with the administration of sugammadex are of concern? Choose all that apply (no vs yes) | ||||||
| Cardiovascular effects | 13 (31.71%) | 5 (27.78%) | 8 (34.78%) | 0.742 | ||
| Respiratory effects | 36 (14.63%) | 3 (16.67%) | 3 (13.04%) | 0.999 | ||
| Nausea and vomiting | 3 (7.32%) | 2 (11.11%) | 1 (4.35%) | 0.573 | ||
| Anaphylaxis | 25 (60.98%) | 12 (66.67%) | 13 (56.52%) | 0.54 | ||
| Inadequate reversal of neuromuscular blockade | 13 (31.71%) | 4 (22.22%) | 9 (39.13%) | 0.321 | ||
| Other | - | |||||
| The appropriate TOF ratio prior to extubation should be | ||||||
| 61%-70% | 12 (13.79%) | 37 (43.2) | 9 (20.45%) | 3 (6.98%) | 0.058 | |
| 71%-80% | 9 (10.34%) | 4 (9.09%) | 5 (11.63%) | |||
| 81%-90% | 16 (18.39%) | 4 (9.09%) | 12 (27.91%) | |||
| 91%-100% | 42 (48.28%) | 21 (47.73%) | 21 (48.84%) | |||
| Knowing TOF ratio before extubation is not important | 8 (9.2%) | 6 (13.64%) | 2 (4.65%) | |||
Descriptive statistical analysis in the total number of respondents and according to the presence/absence of a Post-Anesthesia Care Unit (PACU) at the Department. Description of statistics: Absolute and relative frequencies (%). Statistical tests applied: Fisher's exact test. *Significance (P<0.05)