Traçabilité de la gestion de l’utilisation des curares dans le dossier d’anesthésie en chirurgie viscérale : une étude observationnelle et multicentrique

Abstract: Objectives: To report any item documenting the peroperative muscle relaxant effects management in anaesthesia files issued from visceral surgery processes. Type of study: Prospective, observational and multicenter. Patients and methods: A single operator analysed 1453 files proposed by nine anaesthetists’ teams. The items selected concerned three periods: induction/tracheal intubation, paralysis maintenance, tracheal extubation. Reporting of 40 categories of items was studied. Results: Items related to laryngoscopy and intubation conditions were observed in 43% (0–95) [general average (intercentres min–max)] and in 11% (0–97) of the files, respectively. At least one level of paralysis was reported in 23% (0–96) of the files. For the paralysis maintenance, documentation of an effect appeared in 53% (4–96) of the documents. Neuromuscular assessments preceding the tracheal extubation were retrieved in 43% (12–89) of the notes. Adductor pollicis was concerned for 30% (1–89) of these observations. Detection of level of spontaneous paralysis offset, satisfying to the local standard, appeared in 14% (3–19) of the documents. Pharmacological reversal was noted for 25% (4–67) of the patients; the assessment of the effects so produced was reported in 8% (0–58). Conclusion: In the studied collection, the traceability of the peranaesthetic curarization management appears variable on both qualitative and quantitative levels. The emergence of a dedicated guideline – defining the criteria for producing a good documentation of the muscle relaxant use – becomes necessary to secure these practices for all physicians using muscle relaxants. [Copyright &y& Elsevier]