Publication:

Bloqueadores neuromusculares. Uso racional guiado por neuromonitorización

This narrative review focuses on the use of neuromuscular blockers in anesthesia, their monitoring, and reversal strategies with a specific emphasis on their economic and anesthetic implications. From an economic standpoint, health expenditure in Chile is substantial, underlining the importance of appropriate selection and dosage of medications as a cost containment measure. A comparison of costs between drugs is provided, stressing the significance of making economic decisions that are based on resource efficiency. Neuromuscular blockers are medications that hinder nerve conduction at the motor plate, inducing reversible skeletal muscle paralysis. Their usage is prevalent in anesthesia to aid tracheal intubation, enhance surgical conditions, and reduce the effort needed for ventilation in intubated patients. Monitoring neuromuscular function is crucial for assessing the degree of blockade, managing medication dosages, reversing its effects, and diminishing the occurrence of residual blockade. Concerning reversal strategies, there is a growing preference for sugammadex over neostigmine, despite the former’s higher cost. The safety of sugammadex across various patient demographics is discussed, alongside new evidence supporting the judicious use of neostigmine, guided by quantitative monitoring. In summary, the review underscores the anesthesiologist’s responsibility in utilizing resources wisely, advocating for evidence-based protocols that are guided by quantitative neuromuscular monitoring.