SummaryThe aim of this study was to develop an audit tool to identify prospectively all peri-operative adverse events during airway management in a cost-effective and reproducible way. All patients at VU University Medical Center who required general anaesthesia for elective and emergency surgical procedures were included during a period of 8 weeks. Daily questionnaires and interviews were taken from anaesthesia trainees and anaesthetic department staff members. A total of 2803 patients underwent general anaesthesia, 1384 men and 1419 women, including 2232 elective patients and 571 emergency procedures, 697 paediatric and 2106 adult surgical procedures. A total of 168 airway-related events were reported. The incidence of severe airway management-related events was 24/2803 (0.86%). There were 12 (0.42%) unanticipated ICU admissions, two patients (0.07%) required a surgical airway. There was one (0.04%) death, one cannot intubate cannot oxygenate (0.04%), one aspiration (0.04%) and eight (0.29%) severe desaturations < S p O 2 50%. We suggest that our method to determine and investigate airway management-related adverse events could be adopted by other hospitals.
SummaryWe studied tracheal intubation in manikins and patients with a camera embedded in the tip of the tracheal tube (Vivasight Seven participants complained of a sore throat, comparable with earlier findings for standard laryngoscopy and intubation: five mild; one moderate; and one severe. Tracheal intubation with the Vivasight through the i-gel or Berman airway is an alternative to existing techniques, against which it should be compared in randomised controlled trials in human participants. It has potential as a fast airway rescue technique.
The influence of introducing unrestricted access to sugammadex and quantitative neuromuscular monitors on the incidence of residual neuromuscular block at a tertiary teaching hospital. An audit of 'real-life'.Residual neuromuscular block (RNMB) is a common phenomenon and has been identified as a significant risk factor for adverse postoperative patient outcome. The outcome of a recent randomised, controlled trial suggests that monitor-guided, sugammadex-based reversal of neuromuscular blocking agents (NMBA) may be able to completely eliminate the risk of RNMB 1 .However, it is unclear whether such results could be achieved in a 'real-life' clinical setting. Prior to the availability of quantitative neuromuscular transmission monitors and the unrestricted availability of sugammadex ( 2011), the incidence of RNMB at the Royal Perth Hospital after timing, neostigmine or sugammadex-based reversal was 53%, 59% and 8%, respectively 2 . As a result, Royal Perth Hospital introduced quantitative neuromuscular monitors for each anaesthesia workstation as well as unhindered access to sugammadex. To investigate the effects of these changes four years on (2015), we conducted an audit including all patients receiving NMBA over a two-week period. Ethics approval was obtained from the Royal Perth Hospital Ethics Committee for Human Research (RPH HREC A-15.002). RNMB was assessed by an independent researcher using a quantitative neuromuscular transmission monitor (train of four [TOF] supramaximal stimulation of the ulnar nerve) (NMT monitor, GE Healthcare, Helsinki, Finland) once the anaesthetist had declared the patient 'fit for extubation'. Choice of NMBA, monitoring and reversal were left to the anaesthetist.Data from 140 cases were analysed. Sugammadex, neostigmine or no reversal were used in 80.7%, 2.1% and 17.2%, respectively. Monitoring was used in 79%. The overall incidence of RNMB was 15%. However, failure (versus compliance) to monitor the effects of reversal resulted in 19% (versus 4%, P=0.02) severe RNMB (TOF ratio <0.7) and 33% (versus 13%, P=0.02) of overall RNMB (TOF ratio <0.9).From 2011 to 2015 the use of neuromuscular transmission monitoring increased from 62% to 78%, and the use of sugammadex from 39% to 81%. Using the same audit format utilised in 2011 2 , it appears likely that the observed changes in clinical practice contributed to the significantly reduced risk of RNMB found in 2015. However, the results also underline the crucial role of neuromuscular transmission monitoring. Without this, even the unrestricted use of sugammadex appears to be unable to completely abolish the risk of RNMB. Thus, more emphasis and continuous staff education about the dangers of RNMB as well the benefits Correspondence of neuromuscular transmission monitoring and adequate reversal appear to be required.
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