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Why Are We Using Pulse Oximetry but Not Neuromuscular Monitoring Routinely: The Real World Scenario?

de Boer, Hans D. MD, PhD; Booij, Leo HDJ MD, PhD

doi: 10.1213/ANE.0000000000000072
Letters to the Editor: Letter to the Editor

Department of Anesthesiology and Pain Medicine, Martini General Hospital Groningen, Groningen, the Netherlands,

Department of Anesthesiology and Pain Medicine, Radboud University Medical Center Nijmegen, Nijmegen, the Netherlands

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To the Editor

Pulse oximetry is nearly always used and accepted in the perioperative setting and is part of anesthesia guidelines globally. However, there is neither definitive evidence that its routine use reliably improves outcomes, effectiveness, and efficiency, nor that it reduces intensive care unit admissions or mortality in operative patients.1 In contrast to this universal application of a technology as yet unproven to improve outcome, Kotake et al.2 demonstrate the impact of not using neuromuscular monitoring (a technique about which many publications demonstrate improved outcomes) on the risk of postoperative residual neuromuscular block after reversal with sugammadex.3,4 It is past the time for anesthesiologists and anesthesia societies to develop appropriate guidelines for management of neuromuscular block including the choice of an appropriate neuromuscular blocking agent, adequate reversal when necessary, and recommending that neuromuscular monitoring equipment should be available and used for every patient in whom neuromuscular blocking drugs are used.

Neuromuscular monitoring: welcome in the real world!

Hans D. de Boer MD, PhD

Department of Anesthesiology and Pain Medicine

Martini General Hospital Groningen

Groningen, the Netherlands

Leo HDJ Booij MD, PhD

Department of Anesthesiology and Pain Medicine

Radboud University Medical Center Nijmegen

Nijmegen, the Netherlands

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1. Pedersen T, Moller AM, Hovhannisyan K. Pulse oximetry for perioperative monitoring. Cochrane Database Syst Rev. 2009;7:CD002013
2. Kotake Y, Ochiai R, Suzuki T, Ogawa S, Takagi S, Ozaki M, Nakatsuka I, Takeda J. Reversal with sugammadex in the absence of monitoring did not preclude residual neuromuscular block. Anesth Analg. 2013;117:345–51
3. Murphy GS, Szokol JW, Marymont JH, Greenberg SB, Avram MJ, Vender JS. Residual neuromuscular blockade and critical respiratory events in the postanesthesia care unit. Anesth Analg. 2008;107:130–7
4. Murphy GS, Szokol JW, Avram MJ, Greenberg SB, Marymont JH, Vender JS, Gray J, Landry E, Gupta DK. Intraoperative acceleromyography monitoring reduces symptoms of muscle weakness and improves quality of recovery in the early postoperative period. Anesthesiology. 2011;115:946–54
© 2014 International Anesthesia Research Society