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J Anaesthesiol Clin Pharmacol. 2019 Apr-Jun;35(2):202-214. doi: 10.4103/joacp.JOACP_195_18.

A multicenter survey on the use of neuromuscular blockade in Greece. Does the real-world clinical practice indicate the necessity of guidelines?

Author information

Task Force of the Hellenic Society of Anaesthesiology for the Management of Neuromuscular Blockade, National and Kapodistrian University of Athens, "Attikon" University Hospital, Athens, Greece.
2 Department of Anaesthesiology, School of Medicine, National and Kapodistrian University of Athens, "Attikon" University Hospital, Athens, Greece.
Department of Anaesthesiology, General Hospital of Athens "G. Gennimatas", Athens, Greece.
Department of Anaesthesiology, General Children's Hospital of Athens "Ag. Kyriakou", Athens, Greece.
Department of Anaesthesiology, School of Medicine, University of Crete, University Hospital of Heraklion, Greece.


Background and Aims:

The aim of this study was to investigate the current status of clinical practice regarding neuromuscular blocking drugs and their antagonists in Greece.

Material and Methods:

This is a multicenter survey, including a questionnaire based on previous studies, which was translated and modified by a Task Force of the Hellenic Society of Anaesthesiology. It was completed on a web-based database after invitation via e-mail and was left online for a period of 2 months.


A total of 1,100 questionnaires were sent, with a response rate of 7.9%. 13.7% stated that they do not use neuromuscular monitoring. Rocuronium was most commonly used for intubation ["often" stated by 19 (21.8%) and "very often" by 62 (71.2%)], followed by cis-atracurium, atracurium, and succinylcholine. Neostigmine and sugammadex were both used, with reversal not always administered by 23 (26.4%). Both agents were mostly used at fixed doses and not calculated based on TOF monitoring or body weight. Sugammadex was preferred in special patient groups and in operations of short duration. Reversal was most often administered based on clinical signs of neuromuscular recovery rather than objective monitoring. A significant percentage of respondents used an inadequate TOF ratio for extubation [37 (43.2%) used a TOF ratio <90%]. The reported incidence of observed residual neuromuscular blockade (RNMB) was 44.8%.


Great variability was observed in Greek clinical practice regarding the use of neuromuscular blockade, which indicates serious issues that must be addressed. The needs for educating anesthesia providers and developing official guidelines are obvious in order to improve patient outcomes.


Antagonists; neuromuscular blockade; neuromuscular blocking drugs

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