{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T01:38:54Z","timestamp":1792546734213,"version":"4.5.0"},"reference-count":14,"publisher":"Springer Science and Business Media LLC","license":[{"start":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T00:00:00Z","timestamp":1792454400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T00:00:00Z","timestamp":1792454400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["J Clin Monit Comput"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Quantitative neuromuscular (qNM) monitoring is recommended whenever neuromuscular blocking agents (NMBAs) are administered, but adherence in routine clinical practice remains inconsistent. This audit evaluated adherence to recommended qNM monitoring standards in adult patients undergoing general anesthesia at a Portuguese tertiary hospital. This prospective clinical audit evaluated adherence to recommended qNM monitoring standards in adult patients undergoing general anesthesia at a major Portuguese tertiary hospital. Over five predefined weekdays between March and May 2025, all adult patients receiving general anesthesia across six operating or procedural areas were assessed. Of 329 patients included, 308 (93.6%) received NMBAs. Quantitative neuromuscular monitoring was omitted in 13.0% despite universal device availability. Utilization was lower in ambulatory and obstetrical settings and in procedures lasting less than one hour. Increasing anesthesia duration was associated with greater monitoring use in univariable analysis, but this association was not independent of clinical location. Equipment-related limitations accounted for a small proportion of omissions. This audit demonstrates high but incomplete adherence to qNM monitoring standards. Non-adherence is clustered primarily in procedures lasting less than one hour and in ambulatory and obstetrical settings. Although equipment was universally available, factors beyond equipment availability appear to contribute to incomplete implementation. Additional research is required to better understand the reasons underlying monitoring omission. In the meantime, targeted educational strategies and reinforcement of evidence-based neuromuscular monitoring practices may further enhance perioperative patient safety.<\/jats:p>","DOI":"10.1007\/s10877-026-01492-2","type":"journal-article","created":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T12:21:17Z","timestamp":1792498877000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Quantitative neuromuscular monitoring during general anesthesia: a prospective clinical audit of adherence to international guidelines"],"prefix":"10.1007","author":[{"given":"Carollyne","family":"Dantas de Oliveira","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patr\u00edcia","family":"Vieito","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Afonso","family":"Ferreira","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ana Sofia","family":"M. Fernandes","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eduardo","family":"P. Tavares","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"In\u00eas","family":"Sousa Braga","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jo\u00e3o","family":"Silva","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Margarida","family":"Abreu-Pires","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pedro","family":"Ribeiro Neto","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Z\u00e9lia","family":"Moreira","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sim\u00e3o","family":"Esteves","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,10,20]]},"reference":[{"issue":"1","key":"1492_CR1","doi-asserted-by":"publisher","first-page":"13","DOI":"10.1097\/ALN.0000000000004379","volume":"138","author":"SR Thilen","year":"2023","unstructured":"Thilen SR, Weigel WA, Todd MM, et al. 2023 American Society of Anesthesiologists Practice Guidelines for Monitoring and Antagonism of Neuromuscular Blockade: A Report by the American Society of Anesthesiologists Task Force on Neuromuscular Blockade. Anesthesiology. 2023;138(1):13\u201341. https:\/\/doi.org\/10.1097\/ALN.0000000000004379.","journal-title":"Anesthesiology"},{"issue":"2","key":"1492_CR2","doi-asserted-by":"publisher","first-page":"82","DOI":"10.1097\/EJA.0000000000001769","volume":"40","author":"T Fuchs-Buder","year":"2023","unstructured":"Fuchs-Buder T, Romero CS, Lewald H, et al. Peri-operative management of neuromuscular blockade: A guideline from the European Society of Anaesthesiology and Intensive Care. Eur J Anaesthesiol. 2023;40(2):82\u201394. https:\/\/doi.org\/10.1097\/EJA.0000000000001769.","journal-title":"Eur J Anaesthesiol"},{"issue":"Suppl 1","key":"1492_CR3","doi-asserted-by":"publisher","first-page":"i53","DOI":"10.1093\/bja\/aex318","volume":"119","author":"JM Hunter","year":"2017","unstructured":"Hunter JM. Reversal of residual neuromuscular block: Complications associated with perioperative management of muscle relaxation. Br J Anaesth. 2017;119(Suppl 1):i53\u201362. https:\/\/doi.org\/10.1093\/bja\/aex318.","journal-title":"Br J Anaesth"},{"issue":"4","key":"1492_CR4","doi-asserted-by":"publisher","first-page":"466","DOI":"10.1016\/j.bja.2020.05.063","volume":"125","author":"H Carvalho","year":"2020","unstructured":"Carvalho H, Verdonck M, Biro P, Forget P, Lebrun F, Poelaert J, Rinehart J. Forty years of neuromuscular monitoring and postoperative residual curarisation: A meta-analysis. Br J Anaesth. 2020;125(4):466\u201382. https:\/\/doi.org\/10.1016\/j.bja.2020.05.063.","journal-title":"Br J Anaesth"},{"issue":"1","key":"1492_CR5","doi-asserted-by":"publisher","first-page":"55","DOI":"10.21454\/rjaic.7518.251.nrm","volume":"25","author":"M Du\u0163u","year":"2018","unstructured":"Du\u0163u M, Iva\u015fcu R, Tudorache O, Morlova D, Stanca A, Negoi\u0163\u0103 S, Corneci D. Neuromuscular monitoring: an update. Rom J Anaesth Intensive Care. 2018;25(1):55\u201360. https:\/\/doi.org\/10.21454\/rjaic.7518.251.nrm.","journal-title":"Rom J Anaesth Intensive Care"},{"issue":"4","key":"1492_CR6","doi-asserted-by":"publisher","first-page":"765","DOI":"10.1097\/00000542-199704000-00005","volume":"86","author":"AF Kopman","year":"1997","unstructured":"Kopman AF, Yee PS, Neuman GG. Relationship of the train-of-four fade ratio to clinical signs and symptoms of residual paralysis in awake volunteers. Anesthesiology. 1997;86(4):765\u201371. https:\/\/doi.org\/10.1097\/00000542-199704000-00005.","journal-title":"Anesthesiology"},{"issue":"2","key":"1492_CR7","doi-asserted-by":"publisher","first-page":"499","DOI":"10.1016\/j.bja.2018.05.062","volume":"121","author":"JM Hunter","year":"2018","unstructured":"Hunter JM. Qualitative monitoring is inadequate for reliably determining full recovery from neuromuscular block whatever the protocol used. Br J Anaesth. 2018;121(2):499\u2013500. https:\/\/doi.org\/10.1016\/j.bja.2018.05.062.","journal-title":"Br J Anaesth"},{"issue":"6","key":"1492_CR8","doi-asserted-by":"publisher","first-page":"1118","DOI":"10.1213\/ANE.0000000000003714","volume":"128","author":"M Naguib","year":"2019","unstructured":"Naguib M, Kopman AF, Ensor JE, Brull SJ. Anesthesiologists\u2019 overconfidence in neuromuscular monitoring. Anesth Analg. 2019;128(6):1118\u201326. https:\/\/doi.org\/10.1213\/ANE.0000000000003714.","journal-title":"Anesth Analg"},{"issue":"2","key":"1492_CR9","doi-asserted-by":"publisher","first-page":"549","DOI":"10.1007\/s10877-022-00922-1","volume":"37","author":"H Carvalho","year":"2023","unstructured":"Carvalho H, Verdonck M, Lebrun F, Poelaert J, Rinehart J. Availability and use of neuromuscular monitors in Europe. J Clin Monit Comput. 2023;37(2):549\u201358. https:\/\/doi.org\/10.1007\/s10877-022-00922-1.","journal-title":"J Clin Monit Comput"},{"issue":"1","key":"1492_CR10","doi-asserted-by":"publisher","first-page":"110","DOI":"10.1213\/ANE.0b013e3181c07428","volume":"111","author":"M Naguib","year":"2010","unstructured":"Naguib M, Kopman AF, Lien CA, Hunter JM, Lopez A, Brull SJ. Survey of neuromuscular block management in the US and Europe. Anesth Analg. 2010;111(1):110\u20139. https:\/\/doi.org\/10.1213\/ANE.0b013e3181c07428.","journal-title":"Anesth Analg"},{"issue":"5","key":"1492_CR11","doi-asserted-by":"publisher","first-page":"373","DOI":"10.1016\/0021-9681(87)90171-8","volume":"40","author":"ME Charlson","year":"1987","unstructured":"Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40(5):373\u201383. https:\/\/doi.org\/10.1016\/0021-9681(87)90171-8.","journal-title":"J Chronic Dis"},{"issue":"5","key":"1492_CR12","doi-asserted-by":"publisher","first-page":"1042","DOI":"10.1097\/00000542-200305000-00003","volume":"98","author":"B Debaene","year":"2003","unstructured":"Debaene B, Plaud B, Dilly MP, Donati F. Residual paralysis in the postanesthesia care unit after a single intubating dose of nondepolarizing muscle relaxant with an intermediate duration of action. Anesthesiology. 2003;98(5):1042\u20138. https:\/\/doi.org\/10.1097\/00000542-200305000-00003.","journal-title":"Anesthesiology"},{"issue":"3","key":"1492_CR13","doi-asserted-by":"publisher","first-page":"429","DOI":"10.1016\/j.bja.2023.05.019","volume":"131","author":"J Poelaert","year":"2023","unstructured":"Poelaert J, Hunter JM. Educating anaesthetists on neuromuscular monitoring: The challenges continue. Br J Anaesth. 2023;131(3):429\u201331. https:\/\/doi.org\/10.1016\/j.bja.2023.05.019.","journal-title":"Br J Anaesth"},{"key":"1492_CR14","doi-asserted-by":"publisher","first-page":"111709","DOI":"10.1016\/j.jclinane.2024.111709","volume":"101","author":"P Goriacko","year":"2025","unstructured":"Goriacko P, Smith AF, Johnson M, Patel A, Rinehart J. Optimizing neuromuscular monitoring: A quality improvement initiative. J Clin Anesth. 2025;101:111709. https:\/\/doi.org\/10.1016\/j.jclinane.2024.111709.","journal-title":"J Clin Anesth"}],"container-title":["Journal of Clinical Monitoring and Computing"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s10877-026-01492-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s10877-026-01492-2","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s10877-026-01492-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T01:03:24Z","timestamp":1792544604000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s10877-026-01492-2"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,20]]},"references-count":14,"alternative-id":["1492"],"URL":"https:\/\/doi.org\/10.1007\/s10877-026-01492-2","relation":{},"ISSN":["1573-2614"],"issn-type":[{"value":"1573-2614","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,20]]},"assertion":[{"value":"20 May 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"14 August 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"20 October 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"As a Quality Improvement Project, it was waived from Research Ethics Committee approval per the Institutional research guidelines.","order":1,"name":"Ethics","label":"Ethics approval","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Not applicable.","order":2,"name":"Ethics","label":"Consent to participate","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Not applicable.","order":3,"name":"Ethics","label":"Consent to publish","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","label":"Competing interests","group":{"name":"EthicsHeading","label":"Declarations"}}]}}