An observational study of airway management at a Belgian university hospital: use of neuromuscular blocking agents and a description of current practice during rapid sequence induction of anesthesia with intubation
Airway management, Rapid Sequence Induction and Intubation, Neuromuscular Blocking Agents
Published online: May 16 2024
Abstract
Background: Ethical approval for this study was granted by the Ethics Committee of Antwerp University Hospital, Drie Eikenstraat 655, 2650 Edegem on 30th March 2020 (Chairman: Professor Pieter Michielsen, reference EC UZA 20/10/113). Informed patient consent was not required by the ethics committee. Patients were included from 1st June 2020 until 31st August 2020.
Objectives: As part of a broad assessment of airway management in both adult (age ≥ 16 years) and pediatric (age < 16 years) practice, this study aimed to determine which neuromuscular blocking agents (NMBA’s) and antagonists were being used in our anesthesiology department, with special emphasis on RSII. Moreover, this study seeks to determine how RSII was being performed.
Design and setting: A prospective observational study was conducted over a 3-month period in a university hospital in Belgium.
Methods: Following ethical committee approval, all emergency and elective cases requiring airway management by anesthesiologists were included. Details were entered into an electronic database stored on a secure hospital server.
Main outcome measures: The number of different NMBA exposures, along with antagonists, was recorded. During RSII, positioning for preoxygenation, use of gastric drainage, application of cricoid force and use of pre-intubation bag-mask ventilation were noted.
Results: In total, there were 3747 general anesthetics. An NMBA was administered in 60.2%, (rocuronium most common in adults, 57.5%, n=1774). Atracurium was most popular in pediatrics (25.9%, n=171). Succinylcholine was used in 16 patients (4 RSII’s). 36.3% of non-depolarising blocks were antagonized (n=812), most commonly with sugammadex (n=437). RSII was used in 187 patients. In the RSII group, preoxygenation occurred head-up in 53.5%, cricoid force was applied in 19.3% and rocuronium used in 97.9%. Nasogastric drainage before induction, and bag-mask ventilation before intubation were used in 25 and 6 cases respectively.
Conclusions: Rocuronium and atracurium are the most commonly used NMBA’s in the adult and pediatric populations respectively. Approximately one third of non-depolarizing blocks are antagonized, most commonly with sugammadex. Practices during RSII vary greatly.
