A survey of current management of neuromuscular block in the United States and Europe

Anesth Analg. 2010 Jul;111(1):110-9. doi: 10.1213/ANE.0b013e3181c07428. Epub 2009 Nov 12.


Background: Postoperative residual neuromuscular block is a frequent occurrence. Recent surveys of clinical practice in Europe suggest that neuromuscular blocking drugs are often administered without appropriate monitoring. No comparable survey has been undertaken in the United States (US). From this survey, we compared current clinical neuromuscular practice and attitudes between anesthesia practitioners in the US and Europe.

Methods: We conducted an Internet-based survey among anesthesia practitioners in the US and Europe. The Anesthesia Patient Safety Foundation and the European Society of Anaesthesiology e-mailed all of their active members, inviting them to anonymously answer a series of questions on a dedicated Internet Protocol address-sensitive website. The survey was available online for 60 days. The chi(2) test and Fisher's exact test were used to compare clinical survey items between the 2 cohorts.

Results: A total of 2636 completed surveys were received. Most respondents from the US (64.1%) and Europe (52.2%) estimated the incidence of clinically significant postoperative residual neuromuscular weakness to be <1% (P < 0.0001). Routine pharmacologic reversal was less common in Europe than in the US (18% vs 34.2%, respectively; P < 0.0001), and quantitative monitors were available to fewer clinicians in the US (22.7%) than in Europe (70.2%) (P < 0.0001). However, 19.3% of Europeans and 9.4% of Americans never use neuromuscular monitors. Most respondents reported that neither conventional nerve stimulators nor quantitative train-of-four monitors should be part of minimum monitoring standards.

Conclusions: Our results suggest a lack of agreement among anesthesia providers about the best way to monitor neuromuscular function. Efforts to improve awareness by developing formal training programs and/or publishing official guidelines on best practices to reduce the incidence of postoperative neuromuscular weakness and patient morbidity are warranted.

MeSH terms

  • Attitude of Health Personnel
  • Data Interpretation, Statistical
  • Europe
  • Health Care Surveys
  • Health Knowledge, Attitudes, Practice
  • Humans
  • Internet
  • Monitoring, Physiologic
  • Neuromuscular Blockade / adverse effects*
  • Neuromuscular Nondepolarizing Agents / adverse effects*
  • Neuromuscular Nondepolarizing Agents / antagonists & inhibitors
  • Paralysis / chemically induced
  • Paralysis / epidemiology
  • Postoperative Complications / chemically induced*
  • Postoperative Complications / therapy*
  • Public Health
  • Safety
  • Surveys and Questionnaires
  • United States


  • Neuromuscular Nondepolarizing Agents