Perioperative neuromuscular blockade. 2020 update of the SEDAR (Sociedad Espanola de Anestesiologia y Reanimacion) recommendations

Autores de IIS La Fe

• 

  Óscar Díaz Cambronero

  Autor

• Guido Mazzinari

  Autor

Participantes ajenos a IIS La Fe

• Serrano, A.
• Abad-Gurumeta, A.
• Martinez, I. Garutti
• Esteve, N.
• Alday, E.
• Ferrando, C.
• Vila-Caral, P.
• Oyonarte, C. L. Errando
• Grp Trabajo Bloqueo Neuromuscular

Grupos

• Medicina Perioperatoria, Anestesiología y Reanimación

  

  Leader

  Óscar Díaz Cambronero

Abstract

We present an update of the 2020 Recommendations on neuromuscular blockade of the SEDAR. The previous ones dated 2009. A modified Delphi consensus analyisis (experts, working group, and previous extensive bibliographic revision) 10 recommendations were produced: (1) neuromuscular blocking agents were recommended for endotracheal intubation and to avoid faringo-laryngeal and tracheal lesions, including critical care patients. (2) We recommend not to use neuromuscular blocking agents for routine insertion of supraglotic airway devices, and to use it only in cases of airway obstruction or endotracheal intubation through the device. (3) SWe recommend to use a rapid action neuromuscular blocking agent with an hypnotic in rapid sequence induction of anesthesia. (4) We recommed profound neuromuscular block in laparoscopic surgery. (5) We recommend quantitative monitoring Sof neuromuscular blockade during the whole surgical procedure, provided neuromuscular blocking agents have been used. (6) We recommend quantitative monitoring through ulnar nerve stimulation and response evaluation of the adductor pollicis brevis, acceleromyography being the clinical standard. (7) We recommned a recovery of neuromuscular block of at least TOFr >= 0.9 to avoid postoperative residual neuromuscular blockade. (8) We recommend drug reversal of neuromuscular block at the end of general anesthetic, before extubation, provided a TOFr >= 0.9 has not been reached. (9) We recommend to choose anticholinesterases for neuromuscular block reversal only if TOF >= 2 and a TOFr >= 0.9 has not been atained. (10) We recommend to choose sugammadex instead of anticholinesterases for reversal of neuromuscular blockade induced with rocuronium. (c) 2022 Sociedad Espanola de Anestesiologia, Reanimacion y Terapeutica del Dolor. Published by Elsevier Espana, S.L.U. All rights reserved.

Keywords

• Muscle relaxants; Neuromuscular blocking agents; Anesthesia; Perioperative period