Intra-operative Communication Regarding Neuromuscular Blockade: A Survey of Anaesthesiologists and Surgeons

Abstract

Background: Surgeons and anesthesiologists have shared but often-conflicting objectives for neuromuscular relaxation. While surgeons require neuromuscular relaxation to optimize surgical conditions, anesthesiologists must balance these requests for additional muscle relaxation with timely extubation and operating room efficiency. Methods: An internet based survey of anesthesiologists and surgeons was conducted between November 14th and December 4th, 2013. Respondents were asked a series of questions about pre-, intra- and post-operative communication regarding neuromuscular relaxation in open and laparoscopic procedures. Results: A total of 256 anesthesiologists and 254 surgeons completed the survey. The most common reason cited by surgeons for requesting more neuromuscular relaxation in open procedures was difficulty closing the incision (86%) and in laparoscopic procedures it was patients’ breathing or straining while intubated (89%). Anesthesiologists honor surgeon’s requests for additional neuromuscular relaxation 60% of the time via NMB, choosing alternate approaches the remainder of the time. Reasons cited by anaesthesiologists as to why they were unlikely to administer more NMB upon request were that it was too close to the end of surgery (48%) or that they felt the patient was sufficiently relaxed (38%). Conclusions: Surgeons’ requests for additional neuromuscular relaxation at the end of surgery appear to be in conflict with anesthesiologists’ desire for rapid reversal and timely extubation. Neuromuscular management approaches that provide surgeons with adequate muscle relaxation and optimal surgical conditions, while allowing anesthesiologists to provide timely extubation, should be explored.