A survey of current management of neuromuscular block and reversal in Australia and New Zealand

2021 ◽  
pp. 0310057X2199549
Author(s):  
Benjamin L Olesnicky ◽  
Andrew Lindberg ◽  
Frank B Marroquin-Harris ◽  
Kerrie Ren
Keyword(s):  
New Zealand ◽  
Neuromuscular Blockade ◽  
Response Rate ◽  
Neuromuscular Block ◽  
Reversal Agent ◽  
Web Based ◽  
Reversal Agents ◽  
Zealand College ◽  
Clinically Significant ◽  
Contemporary Practice

In recent years there has been a significant investment in education on the management of neuromuscular blockade and increased availability of sugammadex in anaesthetic practice. This survey aimed to examine contemporary practice of Australian and New Zealand anaesthetists in managing neuromuscular blockade and its reversal. A web-based, voluntary survey was distributed to a cohort of 1000 Fellows of the Australian and New Zealand College of Anaesthetists. We received 229 completed responses (survey response rate of 23%). Seventy-one percent (95% confidence interval (CI) 64% to 76%) of the survey respondents thought that 5% or fewer of the patients in their hospital display clinically significant postoperative paralysis. Only 35% (95% CI 18% to 29%) thought that quantitative neuromuscular twitch monitors should be used to monitor neuromuscular block, and the dose and time given for reversal agents was often inconsistent with published recommendations. Sugammadex was the preferred reversal agent for 78% (95% CI 72% to 83%) of survey respondents, but they indicated that cost remains a significant barrier to its widespread uptake. Despite the low response rate, this survey identified that some reported practices in Australia and New Zealand deviate from guidelines and current recommendations in the management of neuromuscular blockade. If the respondents are representative of the broader anaesthetic community, there appears be a greater preference for sugammadex over neostigmine for reversal of neuromuscular blockade.

‘Quit while you are ahead – and smell the roses!’ A survey of retired Fellows of the Australian and New Zealand College of Anaesthetists

2021 ◽  
pp. 0310057X2110057
Author(s):  
Diana Strange Khursandi ◽  
Victoria Eley
Keyword(s):  
Clinical Practice ◽  
New Zealand ◽  
Standard Deviation ◽  
Response Rate ◽  
Common Factors ◽  
Published Data ◽  
Factors Affecting ◽  
Retirement Decisions ◽  
Zealand College ◽  
The Mean

There are no published data on the age of retirement of anaesthetists in Australia and New Zealand. We surveyed 622 retired Fellows of the Australian and New Zealand College of Anaesthetists to determine their ages of complete retirement from clinical practice, demographics, and whether they had retired at the age they had intended to retire. We also aimed to explore factors affecting the decision to retire, the practice of ‘winding down’, common post-retirement activities, and the arrangement of personal and professional affairs. Responses were received from 371 specialists (response rate 60%). The mean (standard deviation) age of retirement was 65.2 (6.9) years. The mean (standard deviation) retirement ages ranged from 62.0 (7.1) years (those who retired earlier than planned) to 68.0 (4.3) years (those who retired later than they had intended). The mean (standard deviation) age of retirement of the male respondents was 66.0 (6.5) years, and for female respondents was 62.7 (7.7) years. Two hundred and thirty-three respondents (63%) reported winding down their practice prior to retirement, and 360 (97%) had made a will. Poor health and loss of confidence were the two most common factors in the retirement decisions of those who retired earlier than they had planned. Our results may assist current practitioners plan for retirement, and suggest strategies to help health services, departments and private groups accommodate individuals in winding down their practice.

scholarly journals Repeat Administration of Reversal Agents in Patients Receiving Neostigmine or Sugammadex: A Retrospective Observational Study

2020 ◽  
Author(s):  
Laura Gilbertson ◽  
Francis Wolf ◽  
Grant C. Lynde
Keyword(s):  
Neuromuscular Blockade ◽  
Repeated Administration ◽  
Not Given ◽  
Reversal Agent ◽  
Progressive Decline ◽  
Residual Neuromuscular Blockade ◽  
Reversal Agents ◽  
Rescue Dose ◽  
Repeat Administration ◽  
Effective Use

Abstract Background: Antagonism of neuromuscular blockade (NMB) induced by rocuronium and vecuronium can be achieved with either neostigmine or sugammadex. Compared to sugammadex, antagonism with neostigmine is more likely to result in incomplete reversal, i.e. residual neuromuscular blockade (rNMB). The administration of additional doses of a reversal agent following an initial reversal dose may be a marker for suspected rNMB. We studied the frequency and temporal patterns of repeat (rescue) administration of reversal agents in patients who received an initial dose of neostigmine vs. sugammadex. Methods: We analyzed retrospective data from electronic anesthesia records to identify surgical patients who received rescue dose reversal, defined as two or more doses of reversal agent, following administration of non-depolarizing NMB and extubation in the operating room. We assessed rates of rescue reversal over time following the introduction of sugammadex and compared rescue rates for patients receiving neostigmine vs sugammadex. Results: A total of 24,027 cases using cisatracurium, rocuronium, and vecuronium were analyzed. Following the addition of sugammadex to formulary in 2016, reversal with neostigmine decreased from 79% to 5.3% (p <0.001) and the use of rescue reversal after neostigmine increased from 6.0% to 18% (p<0.001). In contrast, rescue reversal after sugammadex was 2.5%, with no change over the study period (p=0.059). The percentage of patients who were not given any reversal agent following non-depolarizing NMB decreased from 20% to 13% (p<0.001). As neostigmine usage progressively decreased after introduction of sugammadex, there was a corresponding increase in rescue reversal dosing when initial reversal was attempted with neostigmine. Conclusions: Repeated administration of a reversal agent was 7 times more likely to occur in patients initially reversed with neostigmine compared to sugammadex. This finding likely reflects increased rates of observed weakness in patients reversed with neostigmine. The correlation between decreasing neostigmine use and increasing rescue reversal after neostigmine may indicate a progressive decline in the effective use of neostigmine (as knowledge and experience waned), and/or decreasing confidence in its efficacy.

scholarly journals The rural medical generalist workforce: The Royal New Zealand College of General Practitioners’ 2014 workforce survey results

2016 ◽  
Vol 8 (3) ◽  
pp. 196 ◽  
Author(s):  
Deanne L. Wong ◽  
Garry Nixon
Keyword(s):  
General Practice ◽  
New Zealand ◽  
General Practitioners ◽  
Response Rate ◽  
Hospital Medicine ◽  
International Medical Graduates ◽  
Medical Graduates ◽  
Rural And Urban ◽  
Survey Results ◽  
Zealand College

ABSTRACT INTRODUCTION Previous surveys have revealed a New Zealand rural medical generalist workforce that is mainly male, older and dependent on international medical graduates (IMGs). AIMS To provide a snapshot of the New Zealand rural medical generalist workforce in 2014 and to make comparisons with the urban medical generalist workforce. To assess future workforce losses and find ways to address them. METHODS In March/April 2014, a survey of members of The Royal New Zealand College of General Practitioners used the SurveyMonkey tool. A comparative analysis was undertaken ofself-identified rural and urban respondents. RESULTS The response rate was 55.9% (2525/4514). Of the 2203 working respondents, 17.1% self-identified as rural, working in rural general practice or rural hospital medicine. Compared with urban respondents, more rural generalists were male (57.5% rural vs 45.5% urban; P < 0.01), aged ≥ 55 years (38.2% rural vs 32.6% urban; P = 0.04) and involved in teaching (53.0% rural vs 30.0% urban; P < 0.01). IMGs were an integral part of the rural generalist workforce (52.8% rural vs 38.7% urban; P < 0.01). More rural generalists worked ≥ 36 h per week (66.8% rural vs 50.4% urban; P < 0.01) and they were more likely to retire within the next 10 years (40.4% rural vs 34.7% urban; P = 0.0417). DISCUSSION The rural medical generalist workforce continues to be mainly male, older and consist of a high proportion of IMGs. Findings confirm the fragility of this workforce and highlight the need for renewed efforts to improve recruitment and retention.

scholarly journals Repeat prescribing safety survey

2019 ◽  
Vol 11 (3) ◽  
pp. 243
Author(s):  
Steven Lillis ◽  
Nicki Macklin ◽  
Michael Thorn ◽  
Emma Wicks ◽  
Kristin Good ◽  
...  
Keyword(s):  
General Practice ◽  
New Zealand ◽  
General Practitioners ◽  
Safety Profile ◽  
Response Rate ◽  
Developed Countries ◽  
Expert Group ◽  
Repeat Prescribing ◽  
Accepted Part ◽  
Zealand College

ABSTRACT INTRODUCTIONRepeat prescribing is an accepted part of general practice activities in New Zealand and in many developed countries. However, there has been little research on how this service is used in New Zealand, or on clinicians’ attitudes towards it. AIMTo discover the opinions of vocationally registered general practitioners (GPs) and general practice registrars regarding repeat prescribing, availability of practice policy and mechanisms for issuing such prescriptions. METHODSA survey was developed by an expert group and shared through the Royal New Zealand College of General Practitioners’ (the College) weekly newsletter, epulse, inviting members to participate in the survey. The survey was also emailed to registrars. RESULTSIn total, 144 vocationally registered GPs and 115 registrars responded (n=259), giving a response rate of 3.2% for GPs and 12.7% for registrars. Patient convenience and time efficiency for the practice were the most commonly cited reasons for repeat prescribing. Registrars had low awareness of practice policy on repeat prescribing and only one-quarter of practices had an orientation pack that contained advice on repeat prescribing. DISCUSSIONBetter practice systems are likely to improve the safety profile of repeat prescribing and should be addressed. There is substantial unwanted variability currently in these practice systems.

Demographics and study practices of psychiatry trainees sitting the RANZCP written examinations

2018 ◽  
Vol 26 (5) ◽  
pp. 551-555 ◽  
Author(s):  
Rahul Khanna ◽  
Gabrielle Matta ◽  
Bharat Visa ◽  
Anna Ryan
Keyword(s):  
New Zealand ◽  
Well Being ◽  
Predictors Of Success ◽  
Multiple Choice Questions ◽  
Web Based ◽  
Exam Preparation ◽  
Zealand College ◽  
The Mean ◽  
The Relationship ◽  
Preparation Techniques

Objectives: This study explored trainee preparation for the Royal Australian and New Zealand College of Psychiatrists (RANZCP) written examinations. We examined the relationship between candidates’ prior psychiatry experience, preparation techniques and expenses, perceptions of the exam and a pass result. We also examined perceptions of well-being. Method: A web-based survey was sent to RANZCP trainees. The association between responses and exam outcome was analysed using SPSS Statistics 23. Results: A total of 23% ( n = 38) of the cohort responded to the survey. Respondents studied for an average of 7.8 months for the essay-style exam and 4.4 months for the multiple-choice questions. The mean months of total psychiatry experience prior to sitting was 36.1 months. Every additional 50 hours of study increased odds of passing by 23%. Respondents who believed that exam preparation would affect outcome had an almost 4-fold higher odds of passing than those who did not. Ratings of well-being before release of results were also positively associated with passing. Conclusions Trainees are sitting the written exams with clinical experience commensurate with RANZCP recommendations. Total study hours and favourable perceptions of exam processes appear to be predictors of success.

Perioperative Management of Patients Receiving New Anticoagulants

2019 ◽  
Vol 25 (19) ◽  
pp. 2149-2157 ◽  
Author(s):  
Massimo Lamperti ◽  
Andrey Khozenko ◽  
Arun Kumar
Keyword(s):  
Vitamin K ◽  
Elective Surgery ◽  
Vitamin K Antagonists ◽  
Oral Anticoagulants ◽  
Oral Intake ◽  
Bleeding Risk ◽  
Dietary Vitamin ◽  
Reversal Agent ◽  
Onset Of Action ◽  
Reversal Agents

There is an increased use of oral anticoagulants for the prevention of venous and arterial thrombosis. Vitamin-K antagonists have been used for decades as the main oral anticoagulants but they have the draback a complex therapeutic management, slow onset of action and by a different oral intake caused by dietary vitamin K intake. New non-vitamin K antagonist oral anticoagulants (NOACs) have been developed to overcome the limitations of warfarin. Their management is easier as it requires a fixed daily dose without coagulation monitoring. Although their therapeutic profile is safe, proper attention should be paid in case of unexpected need for the reversal of their coagulation effect and in case a patient needs to have a scheduled surgery. For non-acute cardiac surgery, discontinuation of NOACs should start at least 48 hours prior surgery. Intracranial bleedings associated with NOACs are less dangerous comparing to those warfarin-induced. NOACs need to be stopped ≥24 hours in case of elective surgery for low bleeding-risk procedures and ≥48 hours for high bleeding-risk surgery in patients with normal renal function and 72 hours in case of reduced CrCl < 80. The therapy with NOACs should be resumed from 48 to 72 hours after the procedure depending on the perceived bleeding, type of surgery and thrombotic risks. There are some available NOAC reversal agents acting within 5 to 20 minutes. In case of lack of reversal agent, adequate diuresis, renal replacement therapy and activated charcoal in case of recent ingestion should be considered.

Estimating the number of cases during COVID-19 pandemics using a web-based tool: first week results of “COVID-19 TRENDS” social media project in the Araba-Alava province in Basque country, Spain. (Preprint)

2020 ◽  
Author(s):  
Ignacio Garitano ◽  
Manuel Linares ◽  
Laura Santos ◽  
Ruth Gil ◽  
Elena Lapuente ◽  
...  
Keyword(s):  
Public Health ◽  
Social Media ◽  
Response Rate ◽  
Basque Country ◽  
Case Definition ◽  
Public Health Action ◽  
Web Based ◽  
Health Action ◽  
Estimate Number ◽  
Media Project

UNSTRUCTURED On 28th February a case of COVID-19 was declared in Araba-Álava province, Spain. In Spain, a confinement and movement restrictions were established by Spanish Government at 14th March 2020. We implemented a web-based tool to estimate number of cases during the pandemic. We present the results in Áraba-Álava province. We reached a response rate of 10,3% out a 331.549 population. We found that 22,4 % fulfilled the case definition. This tool rendered useful to inform public health action.

scholarly journals Knowledge and perceptions of cardiopulmonary resuscitation amongst New Zealand podiatrists: a web-based survey

2021 ◽  
Vol 14 (1) ◽  
Author(s):  
Angela Brenton-Rule ◽  
Daniel Harvey ◽  
Kevin Moran ◽  
Daniel O’Brien ◽  
Jonathon Webber
Keyword(s):  
New Zealand ◽  
Cardiopulmonary Resuscitation ◽  
Life Support ◽  
Survival Rates ◽  
Sudden Cardiac Arrest ◽  
Cross Sectional Study ◽  
Trial Registration ◽  
Cross Sectional ◽  
Web Based ◽  
The Past

Abstract Background Podiatrists in New Zealand have a duty of care to assist patients in an emergency, and current cardiopulmonary resuscitation (CPR) certification is a requirement for registration. However, it is unknown how competent and confident podiatrists are in administering CPR and how they would respond in an emergency. Having a health professional who has a competent knowledge of CPR and skills in basic life support, can improve survival rates from sudden cardiac arrest. Therefore, the aim of this study was to survey New Zealand podiatrists to determine their CPR knowledge and qualifications; beliefs about the application of CPR; and perceptions of their competency in CPR. Methods This cross-sectional study used a web-based survey. Participants were New Zealand registered podiatrists with a current annual practising certificate. The 31-item survey included questions to elicit demographic information, CPR practice and attitudes, and CPR knowledge. Responses were collected between March and August 2020. Results 171 podiatrists responded to the survey. 16 % of the podiatrists (n = 28) had performed CPR in an emergency, with a 50 % success rate. Participants were predominantly female (n = 127, 74 %) and working in private practice (n = 140,82 %). Nearly half of respondents were younger than 40 years (n = 75,44 %) and had less than 10 years of clinical experience (n = 73, 43 %). Nearly all (n = 169,97 %) participants had received formal CPR training in the past two years, with 60 % (n = 105) receiving training in the past 12 months. Most respondents (n = 167,98 %) self-estimated their CPR ability as being effective, very effective, or extremely effective. Participants’ knowledge of CPR was variable, with the percentage of correct answers for CPR protocol statements ranging between 20 and 90 %. Conclusions This study provides the first insight into New Zealand podiatrists’ CPR knowledge and perceptions. Podiatrists were found to have high levels of CPR confidence but demonstrated gaps in CPR knowledge. Currently, New Zealand registered podiatrists require biennial CPR re-certification. However, resuscitation authorities in New Zealand and overseas recommend an annual update of CPR skills. Based on this study’s findings, and in line with Australia and the United Kingdom, the authors recommend a change from biennial to annual CPR re-certification for podiatrists in New Zealand. Trial registration The study was registered with the Australian New Zealand Clinical Trials Registry (ACTRN12620001144909).

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