title: [Use of neuromuscular blocking agents in prehospital medicine: practice survey in Emergency Mobile Services of the South-East of France].
abstract: OBJECTIVE
  To evaluate the use of neuromuscular blocking agents (NMBA) in the French adult Prehospital Emergency Medical Services (PEMS).
  
  
  METHODS
  Telephone survey of practices.
  
  
  METHODS
  A survey was conducted from April to July 2009 in every PEMS of the South-East of France. A PEMS physician by center was interviewed using a standardized quiz including demographic data, methods of anesthetic induction, use of NMBA and succinylcholine.
  
  
  RESULTS
  All 86 EMS were interviewed. Succinylcholine was used in 98% of cases for rapid sequence induction. Nondepolarizing NMBA were never used by 38%. They were not available in 21% of PEMS. Among the practitioners using them, 79% prescribed them rarely (less than 25% of intubated patients). Nondepolarizing NMBA were prescribed in more than half of cases of patient ventilator asynchrony by 27% of physicians, of ventilator high pressure (23%), of acute status asthmaticus (23%), of suspicion of intracranial hypertension (22%), of refractory hypoxemia (16%), therapeutic hypothermia (10%). Limitations of prescription were essentially little guidance and lack of training. Atracurium and cisatracurium were the most used. The exact dosages were known by only 18% of practitioners. None of the practitioners were performing a monitoring of NMBA.
  
  
  CONCLUSIONS
  This survey highlights the very frequent use of succinylcholine for rapid sequence induction and low use of nondepolarizing NMBA for selected indications. A training endeavor could be undertaken to improve the use of these anesthetic drugs by prehospital physicians.
authors.affiliation: Smur-Samu 63, CHU de Clermont-Ferrand, 58, rue Montalembert, 63000 Clermont-Ferrand, France.
authors.forename: R
authors.initials: R
authors.lastname: Chabanne
authors.forename: S
authors.initials: S
authors.lastname: Colomb
authors.forename: D
authors.initials: D
authors.lastname: Gonzalez
authors.forename: S
authors.initials: S
authors.lastname: Perbet
mesh_terms: D000328:Adult; D000552:Ambulances; D004363:Drug Utilization; D004632:Emergency Medical Services / Q000706:statistics & numerical data*; D005260:Female; D005602:France; D019538:Health Care Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D009467:Neuromuscular Depolarizing Agents; D003473:Neuromuscular Nondepolarizing Agents / Q000627:therapeutic use*; D012151:Resuscitation; D013390:Succinylcholine; D013689:Telephone
chemical_list: D009467:Neuromuscular Depolarizing Agents; D003473:Neuromuscular Nondepolarizing Agents; D013390:Succinylcholine