Anaesthetists’ knowledge and frequency of use of neuromuscular monitoring at the University of the Witwatersrand

Setsomelo, Michael Kgowe
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Background Neuromuscular blocking agents (NMBA) are commonly administered during general anaesthesia (GA). The use of these agents can result in postoperative residual neuromuscular blockade (PRNMB) as a complication. Studies have shown that such complication can be reduced with the use of neuromuscular monitors (NMM). Data from South Africa as to the knowledge and use of NMM is scanty. Therefore, the aim of this study is to assess the knowledge and the frequency of use of NMM in the Department of Anaesthesia at the University of the Witwatersrand (Wits). Methods A prospective, contextual study design was used. Data was collected using a selfadministered online questionnaire developed by the researcher with the assistance of senior anaesthetists. The study population consisted of all anaesthetists working in the Department of Anaesthesia at Wits. A convenience sampling method was used and a completion with return of the online questionnaire implied consent to participate in the study. Adequate knowledge was defined by a score of 65.5% as determined by the Angoff method. Results Two hundred and eight anaesthetists were available during the period of data collection. Of these, 126 anaesthetists completed the questionnaire. There was inadequate level of knowledge of NMM among anaesthetists in our department. Sixty-four percent of the anaesthetists achieved less than the set Angoff score of 65.5%. The anaesthetist’ mean score of the questionnaire was also 57%. The level of knowledge differs significantly depending on professional designation with p-value <0.009. Medical Officers and second year registrars scored significantly below the Angoff score with p-values of 0.0005 and 0.02 respectively, while first year registrars recorded the highest score, followed by fourth year registrars. The frequency of use of NMM in the department is low at 13%. Conclusion The level of knowledge among anaesthetists with respect to NMM was inadequate. There is a need for improvement of knowledge regarding NMM use, by ongoing education in our anaesthesia department. Formulating evidence-based guidelines which support the use of NMM in all patient who received NMBA will be beneficial. The use of NMM in our department is also low. The commonest reason for not using NMM was unavailability of these monitors. Healthcare authorities have the obligation to increase the availability and accessibility of NMM. A national study in this subject is warranted to see if this is any different among anaesthetists in South Africa.
A research report submitted in partial fulfilment of the requirements for the degree of Master of Medicine in Anaesthesia to the Faculty of Health Sciences, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, 2022