Date of Award
Doctor of Nursing Practice (DNP)
Background/Significance: A large population of patients entering the post-operative anesthesia care unit (PACU) with residual neuromuscular blockade (NMB), as defined by a Train-of-Four ratio < 0.9, has been reported in the literature. Patients with residual NMB have a higher likelihood of respiratory insufficiency and failure, and many others experience uncomfortable feelings of muscle weakness. Neostigmine is a commonly used agent to reverse NMB, but little is known about factors which affect use and dosing.
Purpose/Objectives: The purpose of this Scholarly Leadership Project was to identify the factors being considered by anesthesia providers when using neostigmine as a reversal agent for NMB. The findings from this study and current evidence were utilized in the formulation of a set of evidence-based practice guidelines for the reversal of NMB with neostigmine.
Design: This study utilized a descriptive, online survey design.
Methods: A survey was sent through the email LISTSERV of the Illinois Association of Nurse Anesthetists (IANA), the official professional organization of certified registered nurse anesthetists (CRNAs) in the state of Illinois.192 active CRNA members of the IANA participated. A validated, investigator-developed online survey, which examined the factors being considered by anesthesia providers when using neostigmine, was sent to 1,384 members of the IANA.
Analysis: Descriptive statistics using means, standard deviation, frequencies, and percentages was used to describe the sociodemographics of respondents and the online responses to the survey. Chi square statistics were utilized to examine different factors considered by CRNAs when administering neostigmine.
Findings: This study revealed different factors that anesthesia providers consider when using neostigmine including: quantity and quality of muscle twitches present during train-of-four monitoring, twitches with and without fade, and time elapsed since the last dose of neuromuscular blocking agent. Furthermore, no statistically significant differences were found in the mean score of the factors being considered for neostigmine use between CRNAs in terms of their years of experience, types of practice, institutional settings, and level of education.
Practice Implications: Project results provide an evidence-based practice protocol, which anesthesia providers can use in discerning adequate and appropriate reversal of NMB.
Mayer, Kyle L., "DNP Project: Reversal of Neuromuscular Blockade with Neostigmine: Development of an Evidence-based Practice Protocol" (2016). College of Science and Health Theses and Dissertations. 150.