• R Chabanne, S Colomb, D Gonzalez, and S Perbet.
• Smur-Samu 63, CHU de Clermont-Ferrand, 58, rue Montalembert, 63000 Clermont-Ferrand, France.
• Ann Fr Anesth Reanim. 2011 Sep 1;30(9):636-40.

ObjectiveTo evaluate the use of neuromuscular blocking agents (NMBA) in the French adult Prehospital Emergency Medical Services (PEMS).Study DesignTelephone survey of practices.Materials And MethodsA survey was conducted from April to July 2009 in every PEMS of the South-East of France. A PEMS physician by center was interviewed using a standardized quiz including demographic data, methods of anesthetic induction, use of NMBA and succinylcholine.ResultsAll 86 EMS were interviewed. Succinylcholine was used in 98% of cases for rapid sequence induction. Nondepolarizing NMBA were never used by 38%. They were not available in 21% of PEMS. Among the practitioners using them, 79% prescribed them rarely (less than 25% of intubated patients). Nondepolarizing NMBA were prescribed in more than half of cases of patient ventilator asynchrony by 27% of physicians, of ventilator high pressure (23%), of acute status asthmaticus (23%), of suspicion of intracranial hypertension (22%), of refractory hypoxemia (16%), therapeutic hypothermia (10%). Limitations of prescription were essentially little guidance and lack of training. Atracurium and cisatracurium were the most used. The exact dosages were known by only 18% of practitioners. None of the practitioners were performing a monitoring of NMBA.ConclusionThis survey highlights the very frequent use of succinylcholine for rapid sequence induction and low use of nondepolarizing NMBA for selected indications. A training endeavor could be undertaken to improve the use of these anesthetic drugs by prehospital physicians.Copyright © 2011 Elsevier Masson SAS. All rights reserved.

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