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Cited by 82Anesthesia and Sedative AgentsAnesthesia and Pain ManagementInnovations in Medical Education

Anesthesiologists’ Overconfidence in Their Perceived Knowledge of Neuromuscular Monitoring and Its Relevance to All Aspects of Medical Practice: An International Survey

Naguib, Mohamed, Brull, Sorin J., Hunter, Jennifer M., Kopman, Aaron F., Fülesdi, Béla, Johnson, Ken B., Arkes, Hal R.·2019·Anesthesia & Analgesia
DOI 10.1213/ane.0000000000003714
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Abstract

BACKGROUND: In patients who receive a nondepolarizing neuromuscular blocking drug (NMBD) during anesthesia, undetected postoperative residual neuromuscular block is a common occurrence that carries a risk of potentially serious adverse events, particularly postoperative pulmonary complications. There is abundant evidence that residual block can be prevented when real-time (quantitative) neuromuscular monitoring with measurement of the train-of-four ratio is used to guide NMBD administration and reversal. Nevertheless, a significant percentage of anesthesiologists fail to use quantitative devices or even conventional peripheral nerve stimulators routinely. Our hypothesis was that a contributing factor to the nonutilization of neuromuscular monitoring was anesthesiologists’ overconfidence in their knowledge and ability to manage the use of NMBDs without such guidance. METHODS: We conducted an Internet-based multilingual survey among anesthesiologists worldwide. We asked respondents to answer 9 true/false questions related to the use of neuromuscular blocking drugs. Participants were also asked to rate their confidence in the accuracy of each of their answers on a scale of 50% (pure guess) to 100% (certain of answer). RESULTS: Two thousand five hundred sixty persons accessed the website; of these, 1629 anesthesiologists from 80 countries completed the 9-question survey. The respondents correctly answered only 57% of the questions. In contrast, the mean confidence exhibited by the respondents was 84%, which was significantly greater than their accuracy. Of the 1629 respondents, 1496 (92%) were overconfident. CONCLUSIONS: The anesthesiologists surveyed expressed overconfidence in their knowledge and ability to manage the use of NMBDs. This overconfidence may be partially responsible for the failure to adopt routine perioperative neuromuscular monitoring. When clinicians are highly confident in their knowledge about a procedure, they are less likely to modify their clinical practice or seek further guidance on its use.

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Authors
Naguib, M., Brull, S. J., Hunter, J. M., Kopman, A. F., Fülesdi, B., Johnson, K. B., & Arkes, H. R.
Affiliations
  • Cleveland Clinic Lerner College of Medicine (US)
  • Mayo Clinic in Florida (US)
  • University of Liverpool (GB)
  • Weill Cornell Medicine (US)
  • University of Debrecen (HU)
  • University of Utah (US)
  • The Ohio State University (US)
Corresponding author
Naguib, Mohamed
ORCID
Venue
Anesthesia & Analgesia
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2019-06
Volume
128
Issue
6
Pages
1118-1126
ISSN
0003-2999 (ISSN-L)
DOI
10.1213/ane.0000000000003714
OpenAlex
W2888065053
Cited by
82
References
50
Citations by year
2026: 9 · 2025: 8 · 2024: 10 · 2023: 14 · 2022: 8 · 2021: 8 · 2020: 11 · 2019: 14
FWCI
12.32
Type
journal article
Language
en
Open access
closed
Locations
  • Anesthesia & Analgesia (publishedVersion)
  • PubMed (publishedVersion)
  • University of Debrecen Electronic Archive (University of Debrecen) (submittedVersion)
Topics
  • Health Sciences › Medicine › Anesthesiology and Pain Medicine › Anesthesia and Sedative Agents
  • Health Sciences › Medicine › Surgery › Anesthesia and Pain Management
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Innovations in Medical Education
Keywords
overconfidence, neuromuscular monitoring, neuromuscular blocking agents, train-of-four ratio, residual neuromuscular blockade, nondepolarizing muscle relaxants, postoperative pulmonary complications, peripheral nerve stimulator
MeSH terms
Anesthesiology, Clinical Competence, Decision Making, Humans, Lung Diseases, Neuromuscular Agents, Postoperative Complications, Psychometrics, Surveys and Questionnaires, Risk, Reproducibility of Results, Monitoring, Intraoperative, Neuromuscular Blockade, Internet, Internationality, Delayed Emergence from Anesthesia, Neuromuscular Monitoring

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