Évaluation des pratiques du monitorage neuromusculaire au bloc opératoire par les internes d’Île-de-France

Abstract

There is need to assess our practice of neuromuscular monitoring according to national consensus guidelines. The aim of this study was to evaluate practice adherence to guidelines in teaching hospitals. A questionnaire designed to provide information concerning the use of muscle relaxant for tracheal intubation and surgery, monitoring and antagonism of neuromuscular blockade in teaching hospital was distributed to anaesthesiology residents in training. Among 187 residents, 121 (65%) answered the questionnaire. A neuromuscular transmission monitoring device was reported available in each operating room by 56% (CI 95%: 46-65%) of responders. For tracheal intubation, neuromuscular monitoring was rarely or never used in 54% (CI 95%: 45-63%) of the responses. During the perioperative period and before extubation, neuromuscular monitoring was reported to be used by 56% (CI 95%: 46-65%) and 70% (CI 95%: 60-78%) of the residents respectively. The correct train-of-four ratio (T4/T1> or =0.9) required prior to extubation was respected in 55% (CI 95%: 46-64%) of the responses. When indicated, reversal of neuromuscular blockade was declared to be systematically performed by 49% (CI 95%: 40-58%) of responders. This questionnaire addressed to anaesthesiology residents in training was a practical and objective mean to obtain relevant information concerning our practices. It revealed an inadequate availability of quantitative neuromuscular monitors in the operating room. As a result, neuromuscular monitoring and reversal of neuromuscular blockade were underused. Teaching hospitals should improve their implication in residents' education and adherence to practice guidelines.