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Background: The incidence of postoperative residual curarisation remains unacceptably high. We assessed whether an educational intervention on perioperative neuromuscular block management can reduce it., Methods: In this multicentre, cluster randomised crossover trial, centres were allocated to receive an educational intervention either in a first or a second period. The educational intervention consisted of a lecture about neuromuscular management key points, including quantitative neuromuscular monitoring and use of reversal agents. The lecture was streamed to allow repetition. Additionally, memory cards were distributed in each operating theatre. The primary outcome was postoperative residual curarisation in the PACU. Secondary outcomes were frequency of quantitative neuromuscular monitoring, use of reversal agents, and incidence of postoperative pulmonary complications during hospital stay. Measurements were performed before randomisation and after the first and the second period. The effect of the educational intervention was estimated using multivariable mixed effects logistic regression models., Results: We included 2314 subjects in 34 Spanish centres. Postoperative residual curarisation incidence was not affected by the educational intervention (odds ratio [OR] 0.90 [95% confidence interval {CI}: 0.51-1.58]; P=0.717 and 1.30 [0.73-2.30]; P=0.371] for first and second time-period interaction). The educational intervention increased the quantitative neuromuscular monitor usage (OR 2.04 [95% CI: 1.31-3.19]; P=0.002), the use of reversal agents was unchanged (OR 0.79 [95% CI: 0.50-1.26]; P=0.322), and the incidence of postoperative pulmonary complications decreased (OR 0.19 [95% CI: 0.10-0.35]; P<0.001)., Conclusions: An educational intervention on perioperative neuromuscular block management did not reduce the incidence of postoperative residual curarisation nor increase reversal, despite increased quantitative neuromuscular monitoring. Sugammadex reversal was associated with reduced postoperative residual curarisation. The educational intervention was associated with a decrease in postoperative pulmonary complications., Clinical Trial Registration: NCT03128151., (Copyright © 2023 British Journal of Anaesthesia. Published by Elsevier Ltd. All rights reserved.)

Background: Residual neuromuscular blockade after general anesthesia using nondepolarizing neuromuscular blocking agents has pathophysiological, clinical, and economic consequences. A significant number of patients under muscle relaxation sustain residual curarization., Methods: Observational, prospective, multicenter study of a cohort of patients (Residual Curarization in Spain Study, ReCuSS). Residual blockade was defined as TOFr<0.9. Patients >18 years-old under general anesthesia, including at least one dose of non-depolarizing neuromuscular blocking agents, and transferred extubated and spontaneously ventilating to the postanesthesia care unit were included. Pre- and intraoperative data were recorded, including, patient characteristics, ASA physical status, experience of the anesthesiologist, type of surgery, temperature monitoring, surgery duration, neuromuscular blockade-related parameters, type of anesthesia (halogenated-balanced, intravenous propofol-based, other), and use of neuromuscular monitoring., Results: A total of 763 patients from 26 hospitals were included, 190 patients (26.7%) showing residual paralysis. Female patients were more prone to residual neuromuscular blockade. Length of surgery, type of relaxant used (benzylisoquinolines), halogenated anesthesia, absence of intraoperative specific monitoring, avoidance of drug reversal, and neostigmine reversal (vs. sugammadex), were significantly related to residual blockade. In the postanesthesia care unit, patients with residual neuromuscular blockade had an increased incidence of respiratory events and tracheal reintubation., Conclusions: The incidence of residual blockade in Spain is similar to that published in other settings and countries. Female gender, longer duration of surgery, and halogenated drugs for anesthesia maintenance were related to residual paralysis, as were NMBA specific items, such as the use of benzylisoquinoline drugs, and the absence of reversal or reversal with neostigmine.