Evidence-Based Guidelines for Intraoperative Quantitative Neuromuscular Monitoring

Nondepolarizing neuromuscular blocking agents are routinely used medications vital to anesthetic care. When administering neuromuscular blocking agents, monitoring neuromuscular blockade depth and degree of recovery is a standard of nurse anesthesia practice to facilitate adequate recovery. If not adequately reversed, postoperative residual neuromuscular blockade can cause severe complications. Traditional qualitative neuromuscular monitoring practices largely contribute to the continuing high incidence of postoperative residual neuromuscular blockade, as supported by research that qualitative monitoring methods are insensitive to the depth of blockade and clinical situations, providing unreliable physiologic information. As recommended in practice guidelines by the American Society of Anesthesiologists, quantitative neuromuscular monitoring offers objective neuromuscular function measurements that are shown to reduce the incidence of postoperative residual neuromuscular blockade, hypoxemia, and muscle weakness. This proposed scholarly project focuses on implementing guidelines for reversing nondepolarizing neuromuscular blocking agents using intraoperative quantitative neuromuscular monitoring. During implementation, data will be collected on the incidence of postoperative residual neuromuscular blockade, hypoxemia, and muscle weakness. The quantitative data will be analyzed and compared to traditional qualitative monitoring data. The project team predicts a statistical decrease in the incidence of postoperative residual neuromuscular blockade, hypoxemia, and muscle weakness in patients monitored using quantitative monitoring. Therefore, standardization of quantitatively monitoring neuromuscular blockade into guidelines for routine practice is essential.