Co-author insights on the ASA Neuromuscular Blockade Management Guidelines
Q&A with Prof. Lars I. Eriksson
Nov 8, 2023
The ASA (American Society of Anesthesiologists) and the ESAIC (European Society of Anaesthesiology and Intensive Care) have recently released guidelines stressing the significance of closely monitoring patients given neuromuscular blocking agents during anesthesia. The guidelines underscore the requirement for quantitative neuromuscular monitoring with specialized devices to ensure better patient care and outcomes.
We spoke with Prof. Lars I. Eriksson, Professor and Academic Chair of Anesthesiology and Intensive Care, at Karolinska institute in Stockholm, Sweden, about the most important steps to successfully implement the new guidelines and the potential barriers to succeed.
So, the guidelines are here but why are they such an important milestone?
“The guidelines now come from an array of organizations and national societies and they all uniformly underscores the importance of neuromuscular monitoring as a standard procedure, whenever neuromuscular blocking agents are used in perioperative care”, says Prof. Lars I. Eriksson.
Prof Eriksson adds:
This is also the first step into personalized anesthetic practice in the operating room. We can now tailor the management of neuromuscular block on an individual level and make very precise determinations on how to handle the block for every patient.
It´s a very important step forward to provide the best possible care and improve patient safety.
Implementing a new standard of care might come with several barriers and challenges. How to overcome these and manage a successful guidelines implementation? What are the three most important steps?
“First of all, the implementation of new routines for neuromuscular monitoring requires clear and patient-focused leadership. This is perhaps the most important step to make a broad implementation possible.
I foresee that clinical leaders use the background information covered by the recent guidelines and set the focus on the impact of routine monitoring on improved use of reversal agents, the reduction in residual paralysis and subsequent reduction in postoperative complications and PACU length of stay. The target is to reduce complications related to the airway and respiratory systems. Equally important for clinical leaders will be to provide neuromuscular monitoring devices wherever neuromuscular blocking agents are being used."
– Prof, Eriksson comments.
He continues:
"Secondly, and in parallel, there need to be formal and bedside educational efforts on departmental level, typically by local experts and champions, that can spread knowledge and guide the introductions among clinicians on an every-day basis", Prof. Eriksson says. ”Such efforts need to be tailored according to the baseline status and routines within the department concerning neuromuscular pharmacology and monitoring. “
“Thirdly, clinical leaders need to provide monitoring devices that are readily available and easily adopted by clinical anesthesiologists or nurse anesthetists to overcome typical barriers among clinicians. Needless to say, there is also a need to follow up and assess local compliance and adaptation to new clinical routines and to guide the process forward.”
Going forward then, what is the vision for the future?
Prof. Eriksson concludes:
For many years I have had a clear vision for patients. I hope to see an overall improved intraoperative management of neuromuscular block and improved use of reversal compounds among all clinicians.
By doing that, we will be able to reach the vision to reduce the incidence of residual paralysis to zero.
It is clear that the guidelines for managing neuromuscular blockade are changing the game into a new standard of care, enabling more personalized care and improved patient safety.
Lars I Eriksson, MD, PhD, FRCA is Professor and Academic Chair of Anesthesiology and Intensive care medicine at the Karolinska Institutet and Head of Research and Education and staff anesthesiologist at Function Perioperative Medicine and Intensive Care at the Karolinska University Hospital, Stockholm, Sweden.
