This study presents findings from a survey assessing the current use of neuromuscular blocking agents (NMBAs) among anesthesiologists in the Middle East. Conducted in 2012, the research aimed to evaluate clinical practices related to NMBAs, including drug selection for tracheal intubation, routine monitoring, reversal strategies, and awareness of adverse effects such as residual curarization. The survey was distributed electronically via the TripleM Middle Eastern Yahoo anesthesia group, which comprises over 577 members across 22 institutions in countries including Saudi Arabia, Egypt, Jordan, Oman, Qatar, Bahrain, the United Arab Emirates, and Syria. A total of 71 responses were collected, representing a response rate of approximately 12.3%, with a calculated margin of error of 11.63%.
Cisatracurium emerged as the most frequently chosen NMBA for tracheal intubation, selected by 39% of respondents. Rocuronium followed closely at 35%, while atracurium was used by only 16%. Notably, suxamethonium was rarely used for routine intubation—only 7% of respondents reported its use—indicating a clear shift away from depolarizing agents despite their rapid onset. In contrast, 63% of participants reported using suxamethonium in difficult airway scenarios, highlighting its continued role in emergency intubation settings.
The use of neuromuscular monitoring (NMT) remains suboptimal. Only 35% of anesthesiologists reported routinely using NMT during general anesthesia, while 47% do not monitor at all. Occasional use was reported by just 16%. Among those who did monitor, the train-of-four (TOF) ratio was assessed in 18% of cases, with a threshold of >0.9 considered acceptable for extubation. However, 10% still relied solely on subjective clinical signs, a practice associated with higher risk of residual blockade.
Rocuronium was widely used in daily practice, with 35% of respondents reporting daily use. Despite this, nearly half (49%) reported no history of anaphylaxis linked to rocuronium, although 17% observed skin rashes or bronchospasm post-administration. Residual curarization following rocuronium use was acknowledged by 54% of users—a concerning figure given that even mild residual paralysis can impair airway protection and respiratory function.
Reversal practices were predominantly pharmacologic. Neostigmine was the reversal agent of choice for 78% of those using rocuronium, while sugammadex—an agent capable of rapidly reversing rocuronium—was used occasionally by only 21%. Alarmingly, 79% of respondents reported never using sugammadex, despite its availability in some regional markets.SMPD1 ProteinFormulation This reflects limited access or lack of familiarity with newer reversal agents.K Cadherin Antibody web
In conclusion, this survey reveals significant gaps in neuromuscular management practices across the Middle East.PMID:35095405 High rates of residual curarization, low use of objective monitoring, and underutilization of advanced reversal agents like sugammadex point to a need for improved education and standardized guidelines. The data underscore the importance of increasing awareness about the high incidence of postoperative residual curarization (>20%) and the critical role of routine neuromuscular monitoring. Implementing formal training programs and national or regional guidelines could help bridge these gaps and enhance patient safety in anesthesia care.MedChemExpress (MCE) offers a wide range of high-quality research chemicals and biochemicals (novel life-science reagents, reference compounds and natural compounds) for scientific use. We have professionally experienced and friendly staff to meet your needs. We are a competent and trustworthy partner for your research and scientific projects.Related websites: https://www.medchemexpress.com