Abstract
BackgroundSeveral neuromuscular blocking (NMB) agents are available for clinical use in anesthesia. The present study was performed in order to identify preferences and behaviors of anesthesiologists for using vecuronium, rocuronium or other NMB agents in their clinical practice.Material and methodsThe cross-sectional survey was applied at the Updated Course of the Colegio Mexicano de Anestesiología performed last year. Of 989, 282 (28.5%) surveys were returned.ResultsMost anesthesiologists were working at both public and private hospitals, performed anesthetic procedures for hospitalized and ambulatory patients, and anesthetized children as well as adults. Respondents did not consider mechanomyography as the gold standard method for neuromuscular monitoring. The T25 was not recognized as a pharmacodynamic parameter that represents the clinical duration of the neuromuscular block. Most answered that vecuronium induces less histamine release than rocuronium, had never used any neuromuscular monitor, did not know the cost of vecuronium and rocuronium, and preferred rocuronium in multiple-sampling vials and vecuronium in either a vial for single or multiple sampling. Rocuronium was preferred for emergency surgery in patients with full stomach only. Almost all of anesthesiologists that conserve the unused drug did it without refrigeration and more than 30% conserve the unused drug in one syringe for further use.ConclusionVecuronium was preferred for most clinical situations, and the decision for this choice was not based on costs. Storage of unused drugs without refrigeration in a single syringe for purpose of future use in several patients represented a dangerous common practice.
Highlights
Several neuromuscular blocking (NMB) agents are available for clinical use in anesthesia
Most answered that vecuronium induces less histamine release than rocuronium, had never used any neuromuscular monitor, did not know the cost of vecuronium and rocuronium, and preferred rocuronium in multiple-sampling vials and vecuronium in either a vial for single or multiple sampling
Vecuronium was preferred for most clinical situations, and the decision for this choice was not based on costs
Summary
Several neuromuscular blocking (NMB) agents are available for clinical use in anesthesia. BMC Anesthesiology 2002, 2 http://www.biomedcentral.com/1471-2253/2/2 polarizing drugs [1,2,3]. According to their chemical structure, two classes of non-depolarizing NMB agents have been available for clinical use, the aminosteroidal (pancuronium, vecuronium and rocuronium) and benzylisoquinoline drugs (atracurium, mivacurium and cisatracurium). Rocuronium has a faster onset of action than vecuronium [5,6], and its metabolites by lacking pharmacological effects avoid any residual neuromuscular block [7]. These characteristics favor rocuronium as a better alternative than vecuronium. In relation to the benzilisoquinoline drugs, these type of NMB agents produce cardiovascular response and clinical evidence of histamine release even at recommended doses [8,9]
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