Reducing the Incidence of PostOperative Residual Curarization

Study Overview
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Brief Summary
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The NMB (Neuromuscular Blockade) is the most frequent complication in anesthesiology associated with an increase in adverse respiratory events in the postoperative period. Its appearance depends on multiple factors. The introduction of a comprehensive educational strategy aimed at promoting the proper management of NMB in the intraoperative period and a package of measures that must be performed (intraoperative neuromuscular monitoring and reversal of the effect of neuromuscular blockers) may contribute to a decrease in the incidence of NMB, Increase safety in the surgical patient and decrease associated costs.

Detailed Description
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Multicenter, epidemiological, prospective, randomized, sequential study. The introduction of an educational program and a package of clinical measures (specific monitoring and pharmacological reversion) in the incidence of NMB will be evaluated by evaluating variations in this incidence of NMB, the rate of compliance with the preventive measures and the perception of the Safety in the perioperative, through pre and postoperative survey.

Official Title
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PORCzero: PostOperative Residual Curarization

Conditions
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Neuromuscular Blockade

Intervention / Treatment
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* Behavioral: Educational program for clinicians: implementation of a package of clinical prevention measures of NMB


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Patients older than 18 years. Classification of the American Society of Anesthesiologists (ASA I-III). Patients with absence of cognitive deficit. Informed informed consent prior to surgery Exclusion Criteria: Negative of the patient to participate in the study Patients under the age of 18 or incapable of giving their consent ASA IV-V Pregnancy or breastfeeding Associated neuromuscular disorders Diabetes mellitus with diagnosed neuropathy

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Study group<br>Intraoperative neuromuscular monitoring and pharmacological reversion according to data sheet | Behavioral: Educational program for clinicians: implementation of a package of clinical prevention measures of NMB<br>* Intraoperative neuromuscular monitoring and pharmacological reversion of NMB according to data sheet<br>|
| Control group<br>Treated according to usual clinical practice | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Incidence of PORC. | To reduce the incidence of PORC ≤ 10% by the introduction of an educational program and a bundle of preventive measures (including intraoperative monitoring and reversal of neuromuscular blocking agents (NMBA)). | Six months, first three months to evaluate PORC incidence and then three months to evaluate PORC incidence after educational intervention. | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Compliance rate with the bundle of measures | To evaluate if the educational program increases compliance of clinical preventive measures, if the reduction of incidence of BNMR is maintained, and, in addition, if this compliance is maintained over time. | Six months, first three months to evaluate PORC incidence and then three months to evaluate PORC incidence after educational intervention. | 
| Rate of intraoperative monitoring | Rate of compliance of clinical prevention measures with intraoperative monitoring. | Six months, from the beginning, with no intervention, until the end of phase III (end of recruitment in both groups). | 
| Rate of reversal of NMBA | Rate of compliance of clinical prevention measures with NMBA reversal after surgery. | Six months, from the beginning, with no intervention, until the end of phase III (end of recruitment in both groups). | 
| Perception of safety -increase- by anesthesiologists | To evaluate, from the point of view of patient safety, whether the perception of safety by clinicians is maintained, through a survey before and after the intervention. | Six months, from the beginning, with no intervention, until the end of phase III (end of recruitment in both groups). | 
| Incidence of postoperative adverse events. | Incidence of postoperative complications in relation to the NMB reversal rate. | Six months, from the beginning, with no intervention, until the end of phase III (end of recruitment in both groups). | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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NMB (Neuromuscular Blockade), Anesthesia, Curarization, TOFr (train of four), PACU (postanesthesia care unit), Monitorization