Current status of neuromuscular reversal and neuromuscular monitoring in China: a cross-sectional survey.

BACKGROUND AND

OBJECTIVE

Residual neuromuscular blockade (rNMB) is associated with perioperative pulmonary complications. Effective neuromuscular monitoring and the use of reversal agents can help reduce rNMB. We surveyed the current practices of neuromuscular reversal and neuromuscular monitoring among anesthesiologists in China.

METHODS

We released a questionnaire containing 25 questions via the New Youth Anesthesia Forum and promoted it through WeChat. We allowed one submission from each IP address. The survey was available online for 30 days. Data were analyzed using descriptive statistics, chi-square tests, and logistic regression analysis.

RESULTS

We analyzed 3,168 valid questionnaires. Rocuronium (41.76%) and cisatracurium (38.83%) were the most frequently used neuromuscular blocking agents. Only 40.09% of respondents routinely administered pharmacological reversal agents, with neostigmine being the predominant choice (61.11% of total respondents) and sugammadex used by merely 19.03%. The adoption of quantitative neuromuscular monitoring was low, with only 1.61% (n = 51) reported routinely utilizing quantitative monitoring (TOF ratio measurement), while 98.01% relied solely on subjective clinical signs. Logistic regression identified that advanced education (master's or higher) and senior academic rank (associate chief or chief physician) independently predicted greater adoption of neuromuscular monitoring. Anesthesiologists in primary and secondary hospitals demonstrated significantly lower adherence to both antagonist administration and objective monitoring compared to those in tertiary centers.

CONCLUSIONS

Our findings reveal substantial gaps in adherence to evidence-based practices for managing rNMB in China, particularly concerning the underutilization of quantitative monitoring and sugammadex. Systemic interventions to improve equipment accessibility, drug availability, and targeted education are crucial to enhance patient safety. Policy-driven resource allocation and standardized training programs are recommended to bridge the gap between evidence and practice.