November 2006.

Neuromuscular blocking agents (NMBAs) can be associated with severe patient harm and death, and carry the highest risk of causing injury and misuse. The United States Pharmacopeia (USP) Medication Errors Reporting Program has received well over 50 reports concerning misuse of these agents over the past several years, and estimates that the true incidence of injuries may likely be much higher than that reported.¹

The USP’s review and analysis showed a continuing risk of patient harm or death due to errors with NMBAs. The American Society of Anesthesiologists recently summarized an alert from the Institute for Safe Medication Practices (ISMP), noting that an inadequate knowledge of the actions of NMBAs contributes to errors.² The summary stated that NMBAs have been inadvertently administered to patients who were not receiving proper ventilator assistance. Death and serious permanent injuries have resulted from giving an NMBA after the patient is extubated or before the patient is intubated. Since each of the various neuromuscular blocking agents have differing adverse events (with respect to the incidence of anaphylaxis, hypotension, bronchospasm, and allergic reactions), familiarity with the profiles of individual agents is necessary to avoid serious adverse events. Drug-drug interactions can also be a problem, and physicians need to be aware of the potential agents that can react with NMBAs.

The interdisciplinary USP Safe Medication Use Expert Committee summarized its recommendations for handling NMBAs safely and effectively³, citing the need for “focused education” and practitioner credentialing for the safe use of NMBAs. The article noted that “increased awareness and action on the part of . . . all practitioners involved in the entire medication use process are needed to improve the safety of this class of medications.” The authors recommended that these professionals “be trained to recognize NMBAs and to know their mechanisms of action and associated risks.”

The format and design of “Neuromuscular Blocking Agents” as a print-based, distance-learning activity has previously proven to be a credible and well-liked vehicle for the continuing medical education of physicians and to help improve overall patient care. This is evidenced by the rising numbers of physicians participating in such activities over the last two years, as evidenced by data compiled by the ACCME from its accredited providers.

This CME activity will include a CME quiz, which will allow participants to test their skills and their knowledge of the material presented in the educational activity. An evaluation assessment questionnaire will provide participants with a means to assess the activity’s quality, fairness and balance, and value of the educational activity to their clinical practice.

Bruce F. Cullen, MD
Professor, Department of Anesthesiology
University of Washington School of Medicine
Attending Anesthesiologist
Harborview Medical Center
Seattle, Washington
Dr. Cullen has disclosed that he had/has no financial relationships/interests with commercial companies
pertaining to this educational activity.

Robert K. Stoelting, MD
Emeritus Professor and Chair, Department of
Anesthesiology
Indiana University School of Medicine
Indianapolis, Indiana
Dr. Stoelting has disclosed that he had/has no relationships/interests with commercial companies pertaining to this educational activity.

Authors

David R. Bevan, MB
Retired
Professor and Chair, Department of Anesthesiology
University of Toronto
Anesthesiologist-in-Chief
University Health Network
Toronto, Ontario, Canada
Dr. Bevan has disclosed that he had/has the following financial relationships/interests with commercial companies pertaining to this educational activity: Consultant: Organon

François Donati, PhD, MD, FRCPC
Professor, Department of Anesthesiology
University of Montreal
Staff Anesthesiologist
Hospital Maisonneuve-Rosemont
Montreal, Quebec, Canada
Dr. Donati has disclosed that he had/has the following financial relationships/interests with commercial companies pertaining to this educational activity. Grant/Research: Organon; Consultant: Organon

COI Peer Reviewers

Manuel Lopes Fontes, MD
Associate Professor of Anesthesiology & Critical Care
Co-Director of Cardiothoracic Intensive Care Unit
Weill Medical College of Cornell University
Department of Anesthesiology
New York, New York
Dr. Fontes has disclosed that he had/has no financial relationships/interests with commercial companies pertaining to this educational activity.

David M. Rothenberg, MD, FCCM
Associate Dean, Academic Affiliations
Professor of Anesthesiology
Co-Medical Director, SICU
Rush University Medical Center
Chicago, Illinois
Dr. Rothenberg has disclosed that he had/has no financial relationships/interests with commercial companies pertaining to this educational activity.