General anaesthesia and neuromuscular blockade techniques in a regional and university hospitals– a three-month bicentric observational study
Authors:
Adamus Milan 1,2; Herold Ivan 3; Částková Adéla 1; Obare Pyszková Lenka 1; Reichelová Denisa 1; Nováček Jiří 3; Sittová Naděžda 3; Čurdová Marcela 3; Hrabálek Lumír 2,4
Authors‘ workplace:
Klinika anesteziologie, resuscitace a intenzivní medicíny, Fakultní nemocnice Olomouc
1; Lékařská fakulta Univerzity Palackého v Olomouci
2; Anesteziologicko-resuscitační oddělení, Oblastní nemocnice Mladá Boleslav, a. s.
3; Neurochirurgická klinika, Fakultní nemocnice Olomouc
4
Published in:
Anest. intenziv. Med., 24, 2013, č. 5, s. 311-320
Category:
Anaesthesiology - Original Paper
Overview
Objective:
Comparison of general anaesthesia techniques focused on neuromuscular blockade in a regional and university hospitals.
Design:
Retrospective study, three-month analysis of anaesthesia charts.
Setting:
Departments of Anaesthesiology and Intensive Therapy of a regional and university hospitals.
Materials and methods:
Anaesthetic charts for all anae-stetic procedures performed in a regional (MB2011) and university (FNOL2011) hospitals during a 3-month period (September- November 2011) were analysed, focusing on patients‘ demographic data, type and lenght of anaesthesia, airway maintainance, neuromuscular blockade, techniques of block reversal and monitoring. The data were compared between the hospitals (unpaired t-test, Fisher exact, Chi-squared test) with statistical significance p < 0.05.
Results:
The total number of anaesthetic procedures performed in MB2011 was 2886, in FNOL2011 4746. General anaesthesia was more frequent in FNOL2011 (92.5%) than in MB2011 (55.5%, p < 0.0001), where 27.3% of procedures were performed in regional anaesthesia (alone or supplemented with analgosedation). Procedures lasting less than 60 minutes were more frequent in MB2011 (69.2%), whereas in FNOL2011 procedures lasting over 60 minutes prevailed (64.7%). LMA was used more often in MB2011 (26.5%) than in FNOL2011 (14.2%, p < 0.0001) for airway maintenance. Neuromuscular blockade was utilised more often in FNOL2011 (61.7%) than in MB2011 (41.5%, p < 0.0001). Rocuronium was the most frequently used NMBA (MB2011 88.5%, FNOL 75.5%, p < 0.0001). Depth of blockade was monitored in 52.1% patients in MB2011, compared to 8.5% patients in FNOL2011, p < 0.0001). Neuromuscular blockade was reversed with neostigmine in 89.8% patients (MB2011) vs. 18.3% (FNOL2011, p < 0.0001), with mean dose of 0.024 ± 0.007 mg/kg (MB2011) vs. 0.019 ± 0.025 mg/kg (FNOL2011, p < 0.0001).
Conclusion:
We observed differences in anaesthesia care procedures between a regional and university hospitals.
Keywords:
general anaesthesia – airway – neuromuscular blockade – reversal – monitoring
Sources
1. http://www.uzis.cz
2. Herold, I., Sittová, N., Čurdová, M., Adamus, M. Použití svalových relaxancií při celkové anestezii v operačních oborech – tříměsíční unicentrická studie v české regionální nemocnici. Anest. intenziv. Med., 2012, 23, 1, p. 6–13.
3. Černý, V., Adamus, M., Cvachovec, K., Ševčík, P., Herold, I. Anestezie v České republice 2010 – jednodenní prospektivní observační dotazníková studie. Anest. intenziv. Med., 2011, 22, 1, p. 5–12.
4. Adamus, M., Herold, I., Cvachovec, K., Ševčík, P., Černý, V. Svalová relaxace během celkové anestezie v České republice 2010 – jednodenní prospektivní observační dotazníková studie. Anest. intenziv. Med., 2011, 22, 2, p. 82–89.
5. Černý, V., Cvachovec, K., Ševčík, P. et al. Doba úvodu a zotavení z celkové anestezie – prospektivní studie. Anest. intenziv. Med., 2009, 20, 5, p. 236–240.
6. http://www.csarim.cz
7. Adamus, M., Herold, I. Sugammadex z pohledu medicíny založené na důkazech. Anest. intenziv. Med., 2012, 23, 5, p. 237–241.
8. Cvachovec, K. Nová farmaka – jak s nimi? Anest. intenziv. Med., 2011, 22, 4, p. 197–199.
9. Kopman, A. F. Neostigmine versus sugammadex: which, when, and how much? Anesthesiology, 2010, 113, 5, p. 1010–1011.
10. Miller, R. D., Ward, T. A. Monitoring and pharmacologic reversal of a nondepolarizing neuromuscular blockade should be routine. Anesth. Analg., 2010, 111, 1, p. 3–5.
11. Kopman, A. F., Eikermann, M. Antagonism of non-depolarising neuromuscular block: current practice. Anaesthesia, 2009, 64, Suppl. 1, p. 22–30.
12. Adamus, M., Bělohlávek, R., Vujčíková, M., Janásková, E. Vliv odlišných dávek rocuronia na jeho farmakodynamický profil: prospektivní studie. Anest. intenziv. Med., 2004, 15, 6, p. 269–275.
13. Williamson, R. M., Mallaiah, S., Barclay, P. Rocuronium and sugammadex for rapid sequence induction of obstetric general anaesthesia. Acta Anaesthesiol. Scand., 2011, 55, 6, p. 694–699.
14. Lee, C., Jahr, J. S., Candiotti, K. A., Warriner, B., Zor-now, M. H., Naguib, M. Reversal of profound neuromuscular block by sugammadex administered three minutes after rocuronium: a comparison with spontaneous recovery from succinylcholine. Anesthesiology, 2009, 110, 5, p. 1020–1025.
15. Marsch, S. C., Steiner, L., Bucher, E., Pargger, H., Schumann, M.,Aebi, T., Hunziker, P. R., Siegemund, M. Succinylcholine versus rocuronium for rapid sequence intubation in intensive care: a prospective, randomized controlled trial. Crit. Care, 2011, 15, p. R199.
16. Sluga, M., Ummenhofer, W., Studer, W., Siegemund, M., Marsch, S. C. Rocuronium versus succinylcholine for rapid sequence induction of anesthesia and endotracheal intubation: a prospective, randomized trial in emergent cases. Anesth. Analg., 2005, 101, p. 1356–1361.
17. Brain, A. I. The laryngeal mask – a new concept in airway management. Br. J. Anaesth., 1983, 55, p. 801–805.
18. Donaldson, W., Abraham, A., Deighan, M., Michalek, P. i-gel™ vs. AuraOnce™ laryngeal mask for general anaesthesia with controlled ventilation in paralyzed patients. Biomed. Pap. Med. Fac. Univ. Palacky Olomouc Czech Repub, 2011, 155, 2, p. 155–163.
19. Naguib, M., Kopman, A. F., Ensor, J. E. Neuromuscular monitoring and postoperative residual curarisation: a meta-analysis. Br. J. Anaesth., 2007, 98, 3, p. 302–316.
20. Debaene, B., Plaud, B., Dilly, M. P., Donati, F. Residual paralysis in the PACU after a single intubating dose of nondepolarizing muscle relaxant with an intermediate duration of action. Anesthesiology, 2003, 98, 5, p. 1042–1048.
21. Donati, F. Neuromuscular monitoring: what evidence do we need to be convinced? Anesth. Analg., 2010, 111, p. 6–8.
22. Murphy, G. S., Brull, S. J. Residual neuromuscular block: lessons unlearned. Part I: definitions, incidence, and adverse physiologic effects of residual neuromuscular block. Anesth. Analg., 2010, 111, 1, p. 120–128.
23. Murphy, G. S., Szokol, J. W., Avram, M. J., Greenberg, S. B., Marymont, J. H., Vender, J. S., Gray, J., Landry, E., Gupta, D. K. Intraoperative acceleromyography monitoring reduces symptoms of muscle weakness and improves quality of recovery in the early postoperative period. Anesthesiology, 2011, 115, 5, p. 946–954.
24. http://www.medgadget.com/2013/05/sedasys-propofol-sedation-system-gets-fda-nod.html
25. http://www.investor.jnj.com/releasedetail.cfm?ReleaseID=761991
26. Perel, A. Non-anaesthesiologists should not be allowed to administer propofol for procedural sedation: a Consensus Statement of 21 European National Societies of Anaesthesia. Eur. J. Anaesthesiol., 2011, 28, 8, p. 580–584.
Labels
Anaesthesiology, Resuscitation and Inten Intensive Care MedicineArticle was published in
Anaesthesiology and Intensive Care Medicine
![Issue 5](https://www.medscope.pro/media/cache/resolve/journal_issue/media/image_pdf/fdf961f5aa1a9dd85645ba926a805f43.jpeg)
2013 Issue 5
- Invasive Pulmonary Aspergillosis – A Common Accompanying Infection in Patients with Severe or Critical Course of COVID-19
- Intestinal Infection of Multi-Resistant NDM-Producing K. pneumoniae in a Patient with NK/T Lymphoma – Case Study
- Vitamins in Prevention and Treatment of COVID-19
- Hybrid Cooperating Complexes in Osteoarthritis Treatment
Most read in this issue
- Pre-eclampsia, eclampsia and HELLP syndrome from the anaesthesiologist’s perspective
- Alternative mini-invasive approaches to calcified aortic valve replacement
- General anaesthesia and neuromuscular blockade techniques in a regional and university hospitals– a three-month bicentric observational study
- Capillary electrophoretic method for formic acidmeasurement after methanol poisoning – casereport