TwitchView Reduces Residual Neuromuscular Block
A Department Chair discusses the benefits of TwitchView.
A 2019 study hypothesized that anesthesiologists were overconfident in their knowledge and ability to manage neuromuscular blocking drugs. To test their hypothesis, an Internet-based multilingual survey was conducted worldwide. 1629 anesthesiologists from 80 countries completed the 9-question survey.
"The respondents correctly answered only 57% of the questions. In contrast, the mean confidence exhibited by the respondents was 84%, which was significantly greater than their accuracy."
The researches concluded this overconfidence partially contributed to anesthesiologists' resistance to adopt routine neuromuscular monitoring.
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Subclinical residual neuromuscular blockade (RNMB) at the time of extubation increases the risk of post operative pulmonary complications between 2 and 3 times baseline2, 3
Residual Neuromuscular Blockade Increases the Cost of Care
Respiratory Complications
The average surgical cost increases 12-fold to $62,704 for patients who experience post-operative respiratory complications4
Unplanned ICU Admissions
Postoperative complications lead to an additional 92,000 ICU admissions and incur a cost of $3.42 billion each year5
Post-Operative Pneumonia
Patients that were not adequately reversed were twice as likely to develop pneumonia with a cost to treat of $6,042 per case6
Quantitative monitoring has been shown to reduce the incidence of RNMB from 62% to <4%7
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1. Edwards LM, Ly NK, Shinefeld J, Morewood GH. Universal Quantitative Neuromuscular Blockade Monitoring at an Academic Medical Center A Multimodal Analysis of the Potential Impact on Clinical Outcomes and Total Cost of Care. Abstract Poster Oct 2020, Anesthesiology 2020 Annual Meeting, Washington, D.C., United States.
2. Fortier LP, McKeen D, Turner K, et al. The RECITE Study: A Canadian Prospective, Multicenter Study of the Incidence and Severity of Residual Neuromuscular Blockade. Anesth Analg . 2015;121(2):366 372. doi:10.1213/ANE.0000000000000757
3. Grabitz SD, Rajaratnam N, Chhagani K, et al. The Effects of Postoperative Residual Neuromuscular Blockade on Hospital Costs and Intensive Care Unit Admission: A Population Based Cohort Study. Anesthesia & Analgesia . 2019;128(6):1129 1136. doi: 10.1213/ANE.0000000000004028
4. Farhan H, Moreno-Duarte I, McLean D, Eikermann M. Residual Paralysis: Does it Influence Outcome After Ambulatory Surgery? Current Anesthesiology Reports. 2014;4(4):290-302.
5. Dimick JB, Chen SL, Taheri PA, Henderson WG, Khuri SF, Campbell DA. Hospital costs associated with surgical complications: a report from the private-sector National Surgical Quality Improvement Program. J Am Coll Surg. 2004;199(4):531–537.
6. Niederman MS, McCombs JS, Unger AN, Kumar A, Popovian R. The cost of treating community-acquired pneumonia, Clin Ther. 1998; 20:820-37.
7. Naguib, M, et al. Consensus Statement on Perioperative Use of neuromuscular Monitoring. Anesth. Analg. 2018; 127(1):71-802
