The use of neuromuscular blockade in the departments of anaesthesia in Slovakia in 2006 – a questionnaire survey. A comparison with the Czech Republic

Overview

Objective:
To evaluate the use of muscle relaxants in anaesthetic departments in Slovakia.

Design:
Prospective, multicentre, questionnaire, correspondence study.

Settings:
Anaesthetic departments, Slovakia.

Materials and methods:
We posted a structured questionnaire regarding the use and choice of muscle relaxants depending on the length of surgery to the heads of 80 Slovak departments of anaesthesia.We were also interested in the methods and techniques of neuromuscular blockade monitoring and the dose regimens for block reversal by neostigmine. Descriptive statistics were used for analyzing the results and a comparison with the Czech Republic was made.

Results:
83% of the questionnaires returned. Nine neuromuscular blockers are currently available in Slovakia (suxamethonium, alcuronium, atracurium, cisatracurium, mivacurium, pancuronium, pipecuronium, rocuronium and vecuronium). Atracurium (65%), rocuronium (58%) and vecuronium (45%) are the most prefered ones. Suxamethonium is most commonly used for patients at risk of aspiration (73%) and to facilitate tracheal intubation in long-lasting operations (61%). A bolus dose with or without top-ups is the most frequent strategy of administration. Timing (47%), precurarization (45%) and priming (27%) are the special procedures most commonly used. Monitoring of neuromuscular blockade relies mainly on clinical judgement (73%), as 33% of departments do not have the monitoring equipment. This is based on economical (47%) and technical (21%) reasons. Neostigmine is usually administered according to clinical signs (86%). The most frequently used dose is 1.0 mg. Neostigmine is routinely administered following every use of a non-depolarizing neuromuscular blocker in 14% of departments.

Conclusion:
The same muscle relaxants are used in Slovakia as in the Czech Republic. An initial bolus and top-ups is the most frequently used strategy for muscle relaxation. Compared to the Czech Republic, the popularity of aminosteroid neuromuscular blockers is higher.There is a noteworthy lack of monitoring facilities in the Slovak anaesthetic departments. A relatively small dose of neostigmine is used for reversal.

Key words:
neuromuscular block – neuromuscular blocker – neostigmine – monitoring – questionnaire survey