Q1. Can recurarization occur with Sugammadex?

Q2. What is the incidence rate of residual block when using succinylcholine and how important is it?

Dr Hugo Carvalho guides us through the complex world of Anesthesiology and Pharmacology, addressing the prevalent question – “What is the incidence rate of residual block when using succinylcholine and how important is it to monitor it?” Join us as we unpack the under-diagnosis, monitoring intricacies, and significant factors around succinylcholine-induced residual block.

Q3. How can you convince your hospital to invest in Objective NMT Monitoring?

This video delves into the financial and health benefits of Objective NMT monitoring, a revolutionary medical technology. By using real-world evidence and case studies, our expert walks you through the business case for this impactful investment.

Q4. What are the key points of the Belgium SARB 2019 guidelines on management of neuromuscular block?

We discuss new anaesthesia safety guidelines in Belgium that now recommend quantitative neuromuscular monitoring. Dr Guy Cammu explains how the revised 2019 guidelines state that neuromuscular function should be monitored during general anaesthesia. This can be done using either a qualitative train-of-four (TOF) count or a quantitative TOF ratio monitor.

Q5. What are the key points of the UK AAGBI 2021 guidelines on management of neuromuscular blockade?

Dr. Cammu delves into the 2021 recommendations from the Association of Anaesthetists in the United Kingdom. He highlights the pivotal directive which insists on every operating theater (or any location where neuromuscular blocking drugs are used) to be equipped with a quantitative neuromuscular monitoring device. Underlining the significance of achieving and documenting a TOF ratio greater than 0.9 before a patient’s awakening and extubation. Dr. Cammu emphasizes the ulnar nerve’s position as the optimal site for neuromuscular monitoring. While acknowledging the various monitoring techniques and alternative sites like the facial or tibial nerve, he particularly underscores the substantial risk associated with facial nerve monitoring, being much higher than that measured at the wrist.

Q6. What is the most useful site for neuromuscular monitoring and what are the alternatives options?

Dr. Cammu sheds light on the efficacy of the ulnar nerve as the preferred site for neuromuscular monitoring. Citing UK guidelines, he outlines the myriad of monitoring techniques available, including acceleromyography, electromyography, compressormyography, and kinemyography. Moreover, he presents insights into alternative monitoring sites such as the facial and tibial nerve. The highlight, however, is his emphasis on the increased risk associated with facial nerve monitoring—indicating that the risk of residual paralysis is significantly higher, urging the best practice of switching to ulnar nerve stimulation towards the end of surgery.

Q7. What are the risks of facial nerve monitoring?

Dr Cammu explains the risks of Residual Paralysis with Facial Nerve Monitoring. Uncover why the risk is higher than measurements at the wrists.

Q9. Which muscles are more resistant to neuromuscular blocking agents?

Dr. Cammu delves into the science of neuromuscular blocking agent sensitivity across different muscle groups. He highlights the inherent resistance of certain muscles, like the diaphragm and corrugator supercilli, as compared to highly sensitive muscles such as the pharyngeal and masseter muscles. Uncover the complexities behind the acetylcholine receptor per neuromuscular end plate, and the role it plays in dictating muscle sensitivity towards neuromuscular blocking agents.

Q10. What are the advantages of using EMG monitors?

Q11. What are the highlights of Europe ESAIC 2023 guidelines on management of neuromuscular blockade? 

Dr. Cammu provides a comprehensive breakdown of the guidelines published by the European Society of Anesthesiology and Intensive Care at the close of 2022, focused on the perioperative use of neuromuscular blockade. Leading the committee was Thomas Fuchs-Buder, who played a pivotal role as the primary author of these significant guidelines.

Q12. When should Neostigmine be used as a reversal agent according to the ESAIC guidelines?

Explore the important role of the TOF ratio in patient safety and why the updated guidelines suggest that neostigmine should only be used when the TOF count is four, and the TOF ratio has recovered to more than 0.2. If you’ve been following old tables and graphs, this is a wakeup call to update your understanding.

Q13. Quantitative vs qualitative vs clinical signs – what does the ESAIC 2023 guidelines say?

Dr. Cammu breaks down the ESAIC 2023 guidelines on the preference between quantitative and qualitative monitoring vs traditional clinical sign methodologies. With a clear emphasis on the superiority of the TOF (Train-of-Four) ratio over the conventional TOF count, he challenges age-old practices of relying on clinical indicators like hand lift, hand grip, and leg tilting. This analysis offers viewers a concise overview of the evolving standards and practices in the world of anaesthesiology based on the latest guidelines.

Q14. What are the key points of the American Society of Anesthesiologists’ (ASA) 2023 guidelines on management of neuromuscular blockade?

In this compelling excerpt from Dr. Cammu’s recent presentation, we journey through the newly introduced guidelines in the United States concerning anesthesiology practices as of early 2023. These guidelines, published in “Anesthesiology”, echo to some extent the European Society’s recommendations but with distinct nuances. Dr. Cammu emphasizes the U.S.’s strict stance against relying solely on clinical assessment for neuromuscular blockade, advocating instead for quantitative over qualitative monitoring to evade potential residual neuromuscular blockades.

Q15. Do we need to monitor when using Sugammadex?

Dr Guy Cammu delves deep into the importance of neuromuscular blockade monitoring during anesthesia, even when using Sugammadex, to prevent residual paralysis. Drawing from a compelling study conducted by Dr.  Kotake, a Japanese anesthetist, we critically discuss the anesthesia practices in countries like Japan where routine clinical care often does not incorporate the use of neuromuscular blockade monitors to guide antagonism.

Q16. Sugammadex vs Neostigmine. What are the clinical outcome differences and associate risks?

Unlock the Future of Anesthesia Reversal Agents. Are you a healthcare professional or medical student striving to make informed decisions about neuromuscular block reversal agents? Look no further! In this video, Dr Guy Cammu dives deep into the clinical outcomes and risks associated with Sugammadex and Neostigmine, two commonly used drugs in anesthesia reversal.

Q17. What are the latest usage data and practices for NMT monitoring in Europe?

In this video, Dr Carvalho takes a closer look at the concerning patterns emerging in anesthesiology practices worldwide. Drawing from extensive survey data, Dr. Carvalho reveals that a significant portion of anesthesiologists, varying by country, regularly use neuromuscular blocking agents without appropriate monitoring. Shockingly, up to 19% rely solely on clinical intuition, foregoing monitoring altogether. Despite this, the confidence level in neuromuscular monitors remains only moderate among professionals, with inaccurate measurements or artifacts cited as primary reasons for distrust. Interestingly, most believe these monitors offer value for their cost.

Q18. Is a TOF Ratio above 100% on an AMG system an artefact?

In another insightful excerpt from Dr. Carvalho’s recent webinar, we delve into the intriguing world of neuromuscular monitors and the challenges anaesthesiologists face in interpreting their readings. Are the reported artefacts genuine errors, or mere misinterpretations? Using compelling visuals, Dr. Carvalho highlights the occurrence of super unitary TOF ratios in monitors employing movement-dependent sensors like acceleromyography or kinemyography. The misreading of such artefacts often leads anaesthesiologists to mistrust and subsequently abandon these tools. This discussion underlines the crucial role of proper education and training to ensure accurate understanding and prevent skepticism. Enhance your knowledge of advanced medical equipment and their practical challenges.

Q19. How do we effectively implement change/adoption of routine neuromuscular blockade monitoring?

Dr. Carvalho explores in this video the challenges faced by anesthesiologists in adopting modern monitoring techniques in operation rooms. Highlighting the latest guidelines from respected institutions like the European Society of Anesthesiology and Intensive Care and the ASA in the US, Dr. Carvalho reveals the gap between monitor availability and its actual use in clinical settings. Delve into the reasons why many anesthesiologists overlook postoperative complications and grasp the significance of peer-to-peer knowledge transfer in this rapidly evolving domain.

Q20. Are we moving in the right direction to eliminate RNB by 2025?

Dr. Hugo Carvalho, a leading expert in the field of anesthesiology and medical monitoring, brings you groundbreaking insights based on his team’s recent meta-analysis. This video is a must-watch for medical professionals, students, and anyone interested in the advancement of medical science and patient safety.

Q21. What are the most common pitfalls in neuromuscular blockade management?

Dr Carvalho explores the common pitfalls in neuromuscular monitoring that clinicians and anesthesiologists often base their conclusions on. We expose these pitfalls and provide practical solutions to help improve patient outcomes in anesthesia practice.

Q22. When does the majority of post operative pulmonary complications occur?

Dive into the complexities of neuromuscular blockade monitoring with this video, as part of the series on “Common Pitfalls in neuromuscular blockade monitoring”. Uncover common misconceptions, understand the implications of residual paralysis and learn how these often-unseen complications significantly affect patient discharge timings from post-anesthesia care units. Ideal for clinicians, anesthesiologists, and aspiring medical students. Expand your knowledge base and enhance your patient care strategies.

Q23. My patient is breathing and moving. Are they ready for extubation?

Q24. How dependable is the time since my last dose of relaxant to determine the time of extubation?

Dr Carvalho presents the results of a comprehensive practical study on over 200 patients, exploring the reliability of using the time since the last administration of neuromuscular blocking agents (such as rocuronium) as a gauge for extubation readiness. Get ready to discover the surprising truth behind the discrepancy between predicted and actual neuromuscular block durations.

Q25. What are the risks of unmonitored antagonization of neuromuscular block?

Dr. Carvalho provides insight on the hazards of unmonitored antagonization, emphasizing that Neostigmine needs to be administered at the right moment according to guidelines. He explains that the Train-of-Four (TOF) ratio plays a crucial role in this process, and unmeasured or inappropriately timed administration can lead to significant variability in the patient’s return to a normal TOF ratio.

Q26. Can we avoid NMBA’s in rapid sequence intubation RSI?

In this video, we look into the findings of a recent study on the use of remifentanil for intubation.  Does avoiding neuromuscular blocking agents lead to better outcomes?  How does remifentanil compare with neuromuscular blockers in intubation success?  And what about those pesky side effects of residual paralysis and post-operative pulmonary complications?

Q27. Can we use Remifentanil instead of Neuromuscular blockers for intubation?

Dr Carvalho delves into a fascinating medical study published earlier this year, exploring the use of Remifentanil for intubation. We ask the key question – could we avoid neuromuscular blocking agents, with their potential side effects of residual paralysis and post-operative pulmonary complications, by using Remifentanil instead?

Q28. What are the unique risks for the paediatric population in management of neuromuscular block?

Dr Carvalho delves deep into the crucial topic of neuromuscular monitoring in pediatric anesthesia. Only 30-40% of clinicians utilize this vital tool, with use often decreasing with experience and increasing usage of Sugammadex.