Why a guideline on peri-operative management of neuromuscular blockade? Why now?

Practice Guidelines for Monitoring Neuromuscular Blockade—Elements to Change to Increase the Quality of Anesthesiological Procedures and How to Improve the Acceleromyographic Method

“…Survey studies in the anesthetic community have also shown that habits and individual experiences with subjective assessments are very strong factors in not monitoring neuromuscular transmission and reversing neuromuscular blockade. In order to improve perioperative anesthetic safety, it is necessary to increase awareness of the risks associated with the uncontrolled use of skeletal muscle relaxants, and to improve the training for the use of medical devices, the forms of self-education, and access to educational materials [26][27][28][29].…”

“…A peripheral nerve stimulator was used to stimulate the ulnar nerve, and the motor responses in the thumb adductor muscle (in the form of thumb movements) were subjectively (visually) observed. In order to use this method as an objective measure of muscle tension, the stimulation process was combined with a visualization and monitoring system [25][26][27].In 1970, Hassan Ali described the first new device for monitoring thumb movement as an element of muscular tone measurements [40]. The first devices for monitoring neuromuscular transmission blockade were separate peripheral nerve stimulators (TOF-Watch, STIMPOD NMS 450, TOF Scan, TOF-Cuf), which later appeared as compatible parts for anesthesia machines-the so-called original equipment manufacturer (OEM) [41][42][43][44].…”

“…The current legislation in Poland requires that the anesthesia workstation be equipped with devices for monitoring the degree of relaxation. The details of the procedure were determined based on the recommendations of the Society of Anesthesiology and Intensive Therapy [24][25][26][27].…”