Recommendations on the use of deep neuromuscular blockade by anaesthesiologists and surgeons. AQUILES (Anestesia QUIrúrgica para Lograr Eficiencia y Seguridad) Consensus.
BACKGROUND
Neuromuscular blockade enables airway management, ventilation and surgical procedures. However there is no national consensus on its routine clinical use. The objective was to establish the degree of agreement among anaesthesiologists and general surgeons on the clinical use of neuromuscular blockade in order to make recommendations to improve its use during surgical procedures.


METHODS
Multidisciplinary consensus study in Spain. Anaesthesiologists experts in neuromuscular blockade management (n=65) and general surgeons (n=36) were included. Delphi methodology was selected. A survey with 17 final questions developed by a dedicated scientific committee was designed. The experts answered the successive questions in two waves. The survey included questions on: type of surgery, type of patient, benefits/harm during and after surgery, impact of objective neuromuscular monitoring and use of reversal drugs, viability of a multidisciplinary and efficient approach to the whole surgical procedure, focussing on the level of neuromuscular blockade.


RESULTS
Five recommendations were agreed: 1) deep neuromuscular blockade is very appropriate for abdominal surgery (degree of agreement 94.1%), 2) and in obese patients (76.2%); 3) deep neuromuscular blockade maintenance until end of surgery might be beneficial in terms of clinical aspects, such as as immobility or better surgical access (86.1 to 72.3%); 4) quantitative monitoring and reversal drugs availability is recommended (89.1%); finally 5) anaesthesiologists/surgeons joint protocols are recommended.


CONCLUSIONS
Collaboration among anaesthesiologists and surgeons has enabled some general recommendations to be established on deep neuromuscular blockade use during abdominal surgery.
Servicios Quirúrgicos, Consorcio Hospital General Universitario de Valencia, Valencia, España. Electronic address: errando013@gmail.com.
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Errando-Oyonarte
Servicio de Cirugía General y Aparato Digestivo, Hospital General La Mancha Centro, Alcázar de San Juan, Ciudad Real, España.
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Moreno-Sanz
Servicio de Anestesiología y Reanimación, Hospital Germans Trias i Pujol, Badalona, Barcelona, España.
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Vila-Caral
Servicio de Cirugía General y Aparato Digestivo, Hospital Universitario de Getafe, Getafe, Madrid, España.
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Ruiz de Adana-Belbel
Servicio de Anestesiología y Reanimación, Complejo Hospitalario Universitario de Granada, Granada, España.
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Vázquez-Alonso
Servicio de Cirugía, Hospital Clínico Universitario de Zaragoza, Zaragoza, España.
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Ramírez-Rodríguez
Servicio de Anestesiología y Reanimación, Complejo Hospitalario Universitario Santa Lucía, Cartagena, Murcia, España.
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Veiga-Ruiz
Servicio de Anestesia y Reanimación, Hospital Universitario La Paz, Madrid, España.
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Guasch-Arévalo
Servicio de Anestesiología y Reanimación, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid, España.
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Lora-Tamayo D'Ocón
D000328:Adult; D000776:Anesthesiology; D000075204:Contraindications, Procedure; D055191:Delayed Emergence from Anesthesia / Q000517:prevention & control; D003697:Delphi Technique; D005104:Expert Testimony; D005260:Female; D013502:General Surgery; D006801:Humans; D058926:Intraoperative Awareness / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D019148:Neuromuscular Blockade / Q000009:adverse effects / Q000379:methods* / Q000592:standards; D009466:Neuromuscular Blocking Agents / Q000008:administration & dosage / Q000009:adverse effects; D061886:Neuromuscular Monitoring; D010820:Physicians / Q000523:psychology
D009466:Neuromuscular Blocking Agents
Anestesia general; Bloqueo neuromuscular; Cirugía general y del aparato digestivo; General anaesthesia; General and digestive surgery; Methods: Delphi; Metodología: Delphi; Monitoring; Monitorización; Muscle relaxants; Muscle relaxation; Neuromuscular blockade; Relajación muscular; Relajantes musculares