BackgroundThe objective of this analysis is to explore potential impact on operating room (OR) efficiency and incidence of residual neuromuscular blockade (RNMB) with use of sugammadex (Bridion™, Merck & Co., Inc., Kenilworth, NJ USA) versus neostigmine for neuromuscular block reversal in Canada.MethodsA discrete event simulation (DES) model was developed to compare ORs using either neostigmine or sugammadex for NMB reversal over one month. Selected inputs included OR procedure and turnover times, hospital policies for paid staff overtime and procedural cancellations due to OR time over-run, and reductions in RNMB and associated complications with sugammadex use. Trials show sugammadex’s impact on OR time and RNMB varies by whether full neuromuscular recovery (train-of-four ratio ≥0.9) is verified prior to extubation in the OR. Scenarios were therefore evaluated reflecting varied assumptions for neuromuscular reversal practices.ResultsWith use of moderate neuromuscular block, when full neuromuscular recovery is verified prior to extubation (93 procedures performed with sugammadex, 91 with neostigmine), use of sugammadex versus neostigmine avoided 2.4 procedural cancellations due to OR time over-run and 33.5 h of paid staff overtime, while saving an average of 62 min per OR day. No difference was observed between comparators for these endpoints in the scenario when full neuromuscular recovery was not verified prior to extubation, however, per procedure risk of RNMB at extubation was reduced from 60% to 4% (reflecting 51 cases prevented), with associated reductions in risks of hypoxemia (12 cases avoided) and upper airway obstruction (23 cases avoided).Sugammadex impact in reversing deep neuromuscular block was evaluated in an exploratory analysis. When it was hypothetically assumed that 30 min of OR time were saved per procedure, the number of paid hours of staff over-time dropped from 84.1 to 32.0, with a 93% reduction in the per patient risk of residual blockade.ConclusionsIn clinical practice within Canada, for the majority of patients currently managed with moderate neuromuscular block, the principal impact of substituting sugammadex for neostigmine is likely to be a reduction in the risk of residual blockade and associated complications. For patients maintained at a deep level of block to the end of the procedure, sugammadex is likely to both enhance OR efficiency and reduce residual block complications.Electronic supplementary materialThe online version of this article (doi:10.1186/s12871-016-0281-3) contains supplementary material, which is available to authorized users.

and CHUK, Burundi. Using a questionnaire based on the World Federation of the Societies of Anaesthesiologists (WFSA) guidelines for safe anaesthesia, we assessed demographic, administrative, peri-operative variables by interviewing anaesthetists in these hospitals, key informants from the Ministry of Health and National Anaesthesia Society of each country. Results: Using the WFSA checklist as a guide, only four percent of respondents were able to provide safe obstetric anaesthesia, and only seven percent reported adequate anaesthesia staffing. There were only 30 anaesthesiologists in Uganda, 168 in Kenya, 22 in Tanzania, 15 in Rwanda, and 2 in Burundi. Hospitals were barely equipped with monitors that sometimes were not functional. The paucity of local protocols, the failed referral system and lack of intensive care unit services was also reported to contribute significantly to poor maternal outcomes. ConClusions: We identified significant shortages of both personnel and equipment needed to provide safe anaesthetic care for obstetric surgical cases across East Africa. There is need to develop policies and strengthen the health systems in order to improve surgical outcomes in developing countries.