Guidelines for Intraoperative Use of Quantitative Neuromuscular Monitoring

Chemical paralysis with neuromuscular blocking agents is common practice in anesthesia. Adequate reversal of these medications is essential for postoperative recovery and return to physiologic baseline. Inadequate reversal may lead to residual paralysis and respiratory complications such as hypoxemia, upper airway obstruction, atelectasis, and pneumonia. Quantitative neuromuscular monitoring was introduced as an objective measure of adequate recovery from neuromuscular blockade. The American Society of Anesthesiologists recommends utilizing quantitative neuromuscular monitoring before tracheal extubation in their 2023 practice guidelines, as the research involving quantitative neuromuscular monitoring shows a reduction in postoperative residual paralysis rates and adverse respiratory complications postoperatively. In this study, the project team will collect data on the target facility’s baseline postoperative residual paralysis rates. During a trial implementation phase, the anesthesia staff will implement the proposed guidelines, and additional data will be collected on postoperative residual paralysis rates following guideline implementation. The data will be compared, and the project team anticipates a statistically significant reduction in the overall incidence of postoperative residual paralysis using quantitative neuromuscular monitoring. If the desired outcomes are unmet, the team will investigate potential causes and adjust the guidelines accordingly.