Anesthesiology research and practice
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Anesthesiol Res Pract · Jan 2015
Neuromuscular monitoring, muscle relaxant use, and reversal at a tertiary teaching hospital 2.5 years after introduction of sugammadex: changes in opinions and clinical practice.
Sugammadex was introduced to Royal Perth Hospital in early 2011 without access restriction. Two departmental audits (26-page online survey and 1-week in-theatre snapshot audit) were undertaken to investigate the change of beliefs and clinical practice related to the use of neuromuscular blocking agents at the Royal Perth Hospital since this introduction. Results were compared with data from 2011. ⋯ All 71 patients observed during the 5-day in-theatre audit were reversed with Sugammadex. Since the introduction of Sugammadex, 69% (n = 20) of respondents felt it provided "faster turnover," less postoperative residual neuromuscular blockade (n = 23; 79%), and higher anesthetist satisfaction (n = 17; 59%). 45% (n = 13) of colleagues reported that they would feel professionally impaired without the unrestricted availability of Sugammadex, and 1 colleague would refuse to work in a hospital without this drug being freely available. In clinical practice Sugammadex was frequently (57%) mildly overdosed, with 200 mg being the most commonly administered dose.
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Anesthesiol Res Pract · Jan 2015
Postoperative Residual Neuromuscular Paralysis at an Australian Tertiary Children's Hospital.
This small (N=64) post-operative audit of children receiving muscle relaxants in an Australian tertiary paediatric hospital identified a 28% incidence of post-operative residual paralysis, measured immediately before extubation.
Worryingly, the incidence of residual paralysis was even higher in the subgroup reversed with neostigmine (38%), which the authors attribute to anaesthetists not waiting long enough after administration.
Severe residual paralysis (TOFR < 0.7) was observed in 7% of cases.
Only 23% of anaesthetists used intra-operative neuromuscular monitoring.
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Anesthesiol Res Pract · Jan 2015
The Availability of Advanced Airway Equipment and Experience with Videolaryngoscopy in the UK: Two UK Surveys.
Fibreoptic intubation, high frequency jet ventilation, and videolaryngoscopy form part of the Royal College of Anaesthetists compulsory higher airway training module. Curriculum delivery requires equipment availability and competent trainers. We sought to establish (1) availability of advanced airway equipment in UK hospitals (Survey I) and (2) if those interested in airway management (Difficult Airway Society (DAS) members) had access to videolaryngoscopes, their basic skill levels and teaching competence with these devices and if they believed that videolaryngoscopy was replacing conventional or fibreoptic laryngoscopy (Survey II). ⋯ The majority rated Macintosh laryngoscopy as the most important airway skill. Members rated fibreoptic intubation and videolaryngoscopy skills equally. Our surveys demonstrate widespread availability of fibreoptic scopes, limited availability of videolaryngoscopes, and limited numbers of experienced videolaryngoscope tutors.
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Anesthesiol Res Pract · Jan 2015
Survey of Accepted Practice following Failed Intubation for Emergency Caesarean Delivery.
Background. There is no consensus on the optimum management of failed tracheal intubation in emergency cesarean delivery performed for fetal compromise. The decision making process on whether to wake the patient or continue anesthesia with a supraglottic airway device is an underexplored area. ⋯ Preoperative patient consent regarding the use of a supraglottic airway device for surgery in the event of failed intubation would affect the decision making of 40% of anaesthetists surveyed. Conclusion. These results demonstrate that a significant body of anesthetists with a subspecialty interest in obstetric anesthesia in the UK would not always wake up the patient and would continue with anesthesia and surgery with a supraglottic airway device in this setting.