Practice trends in atracurium use and reversal among anesthesiologists and anesthesia residents in Sindh, Pakistan

Atracurium besylate is a non-depolarizing neuromuscular blocking agent (NMBA) and is one of the most commonly used agents in general anesthesia, as it undergoes degradation through ester hydrolysis and Hofmann elimination. Anticholinesterase drugs such as neostigmine, often used in conjunction with anticholinergic agents are commonly administered to reverse its effects. However, variations exist in the practices regarding the use of reversal agents after atracurium among different anesthesiologists. This study aims to evaluate the trends among anesthesiologists regarding the use of atracurium and its reversal. It was a cross sectional study conducted over a period of six months. Anesthesiologists with over one year of experience (including both consultants and residents), working in tertiary care hospitals across Sindh were included. Those with less experience or working in smaller setups with no general anesthesia facilities were excluded. Atracurium was the preferred NMBA among 88.9% of respondents. Reversal agents were used routinely by 81%, while 19% used them selectively.Among 189 respondents, 168 (88.9%) reported atracurium use. Of these, 136 (81%) routinely used reversal agents in every patient, while 32 (19%) used them selectively. Spontaneous recovery was the most frequently reported clinical circumstance influencing reversal-agent use (61/168, 36.3%). Only 6 (3.6%) respondents used a nerve stimulator in every patient, whereas 162 (96.4%) used it selectively; among these, 116 (71.6%) reported non-availability as a reason for selective use. Among the 168 respondents who reported using atracurium, 92/168 (54.8%) perceived that complications could occur when reversal agents were omitted, whereas 45.2% reported no complications when reversal agents were omitted.Atracurium use was significantly associated with working sector (99.3% in the public vs. 56.5% in the private sector, p < 0.001) and city (100% outside Karachi vs. 86.5% in Karachi, p = 0.016). Atracurium is the most commonly used NMBA among anesthesiologists and anesthesia residents working in tertiary care hospitals in Sindh. Most respondents routinely administer reversal agents following atracurium use. The findings demonstrate considerable consistency in reversal practices, although variation remains regarding selective use and neuromuscular monitoring. Not applicable.