scholarly journals A Systematic Review Comparing Neostigmine Versus Sugammadex

2019 ◽  
Author(s):  
Brittany Williams
Keyword(s):  
Systematic Review ◽  
Adverse Effects ◽  
Health Care Professionals ◽  
Neuromuscular Blocking ◽  
Systemic Review ◽  
Negative Consequences ◽  
Muscle Paralysis ◽  
Reversal Agent ◽  
Train Of Four ◽  
Postoperative Residual

Postoperative residual muscle paralysis can lead to very serious complications, such as hypoxia, airway obstruction, and generalized muscle weakness after surgical procedures. Traditional anesthesia practice has utilized a class of medications called cholinesterase inhibitors to mitigate these complications. Cholinesterase inhibiting agents have the potential to create adverse effects of their own, such as bradycardia, due to the drug class’s indirect mechanism of action. An ideal reversal agent would reverse quickly, and reliably, with minimal adverse effects. Recently, sugammadex, a selective relaxant- binding agent, has been introduced as an alternative reversal agent. The purpose of this systemic review was to compare the administration of sugammadex versus neostigmine and time to re-establish normal muscular function, as evidenced by a train-of-four (TOF) ratio of 0.9. Databases were searched for pertinent randomized control trials and literature regarding the topic of this review. Inclusion and exclusion criteria were utilized to finalize the five studies that were included in this systematic review. The PRISMA checklist and CASP tool was utilized to extract and critically appraise each study. Additionally, a cross study analysis was performed. Overall, sugammadex was found to be a faster and more reliable reversal agent, with mild-to-moderate adverse effects reported, when compared to the anticholinesterase, neostigmine. Consistently and reliably reversing neuromuscular blocking agents and educating other health care professionals about the negative consequences of postoperative residual muscle paralysis, are initiatives that the advance practice nurse, particularly the CRNA, can lead.

scholarly journals Is dezocine effective and safe in preventing opioids-induced cough during general anaesthesia induction? A protocol for systematic review and meta-analysis

BMJ Open ◽  
2020 ◽  
Vol 10 (6) ◽  
pp. e035691
Author(s):  
Li-xian He ◽  
Ken Shao ◽  
Jie Ma ◽  
Yuan-yuan Zhao ◽  
Yun-tai Yao
Keyword(s):  
Systematic Review ◽  
Adverse Effects ◽  
Treatment Effects ◽  
Meta Analysis ◽  
Biomedical Literature ◽  
Sensitivity Analyses ◽  
Systemic Review ◽  
Cochrane Library ◽  
Significant Heterogeneity ◽  
Anaesthesia Induction

IntroductionCough is often observed when administrating a bolus of opioids. Opioid-induced cough (OIC) is mostly transient, benign and self-limiting, but could be associated with adverse effects. Numerous pharmacological and non-pharmacological interventions have been used to manage OIC with controversial efficacy and safety. Recent studies suggested that, pretreatment of intravenous dezocine (DZC) could completely suppress OIC during anaesthesia induction. To address this knowledge lack, we will perform a systemic review and meta-analysis to evaluate the efficacy of DZC on OIC and possible complications. We provide here a protocol that will outline the methods and analyses planned for the systematic review.MethodsPubMed, Embase, Cochrane Library, Web of Science as well as Chinese BioMedical Literature & Retrieval System (SinoMed), China National Knowledge Infrastructure, Wanfang Data and VIP Data will be searched from 1978 to 31 December 2019 to identify all randomised controlled trials comparing DZC with placebo on the incidence and severity of OIC. Primary outcomes of interest include the incidence and severity of OIC. Secondary outcomes of interest include possible complications or adverse effects of DZC. Two authors will independently extract relevant variables and outcome data. For continuous variables, treatment effects will be calculated as weighted mean difference and 95% CI. For dichotomous data, treatment effects will be calculated as OR and 95% CI. Each outcome will be tested for heterogeneity, and randomised-effects or fixed-effects model will be used in the presence or absence of significant heterogeneity. Sensitivity analyses will be done by examining the influence of statistical model and individual trial(s) on estimated treatment effects. Publication bias will be explored through visual inspection of funnel plots of the outcomes. Statistical significance will be defined as p<0.05.Ethics and disseminationThis study is a protocol of meta-analysis of previously published literatures, ethical approval was not necessary according to the Ethical Committee of Fuwai Hospital. The study will be submitted to a peer-reviewed journal and disseminated via research presentations.PROSPERO registration numberCRD42019141255.

scholarly journals Effect of a Cognitive Aid on Reducing Sugammadex Use and Associated Costs

2019 ◽  
Vol 131 (5) ◽  
pp. 1036-1045 ◽  
Author(s):  
Dan M. Drzymalski ◽  
Roman Schumann ◽  
Frank J. Massaro ◽  
Agnieszka Trzcinka ◽  
Ruben J. Azocar
Keyword(s):  
Interrupted Time Series ◽  
Neuromuscular Blocking ◽  
General Anesthetics ◽  
Interrupted Time Series Analysis ◽  
Reversal Agent ◽  
Reversal Agents ◽  
Respiratory Events ◽  
Train Of Four ◽  
Acquisition Costs ◽  
Adverse Respiratory Events

Abstract Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New Background The authors observed increased pharmaceutical costs after the introduction of sugammadex in our institution. After a request to decrease sugammadex use, the authors implemented a cognitive aid to help choose between reversal agents. The purpose of this study was to determine if sugammadex use changed after cognitive aid implementation. The authors’ hypothesis was that sugammadex use and associated costs would decrease. Methods A cognitive aid suggesting reversal agent doses based on train-of-four count was developed. It was included with each dispensed reversal agent set and in medication dispensing cabinet bins containing reversal agents. An interrupted time series analysis was performed using pharmaceutical invoices and anesthesia records. The primary outcome was the number of sugammadex administrations. Secondary outcomes included total pharmaceutical acquisition costs of neuromuscular blocking drugs and reversal agents, adverse respiratory events, emergence duration, and number of neuromuscular blocking drug administrations. Results Before cognitive aid implementation, the number of sugammadex administrations was increasing at a monthly rate of 20 per 1,000 general anesthetics (P &lt; 0.001). Afterward, the monthly rate was 4 per 1,000 general anesthetics (P = 0.361). One month after cognitive aid implementation, the number of sugammadex administrations decreased by 281 per 1,000 general anesthetics (95% CI, 228 to 333, P &lt; 0.001). In the final study month, there were 509 fewer sugammadex administrations than predicted per 1,000 general anesthetics (95% CI, 366 to 653; P &lt; 0.0001), and total pharmaceutical acquisition costs per 1,000 general anesthetics were $11,947 less than predicted (95% CI, $4,043 to $19,851; P = 0.003). There was no significant change in adverse respiratory events, emergence duration, or administrations of rocuronium, vecuronium, or atracurium. In the final month, there were 75 more suxamethonium administrations than predicted per 1,000 general anesthetics (95% CI, 32 to 119; P = 0.0008). Conclusions Cognitive aid implementation to choose between reversal agents was associated with a decrease in sugammadex use and acquisition costs.

Reversal of Profound Rocuronium-induced Blockade with Sugammadex

2008 ◽  
Vol 109 (5) ◽  
pp. 816-824 ◽  
Author(s):  
R Kevin Jones ◽  
James E. Caldwell ◽  
Sorin J. Brull ◽  
Roy G. Soto
Keyword(s):  
Neuromuscular Blockade ◽  
Geometric Mean ◽  
Randomized Study ◽  
Acetylcholinesterase Inhibitors ◽  
Neuromuscular Blocking ◽  
Phase Iii ◽  
Reversal Agent ◽  
Train Of Four ◽  
American Society ◽  
Intent To Treat

Background Traditionally, reversal of nondepolarizing neuromuscular blocking agents was achieved using acetylcholinesterase inhibitors, but these are unable to adequately reverse profound blockade. Sugammadex is a novel reversal agent, reversing the effects of rocuronium by encapsulation. This study assessed the efficacy and safety of sugammadex versus neostigmine for reversal of profound rocuronium-induced neuromuscular blockade. Methods This phase III, randomized study enrolled surgical patients, aged 18 yr or older with American Society of Anesthesiologists physical status I-IV. Patients were randomized to receive sugammadex (4.0 mg/kg) or neostigmine (70 microg/kg) plus glycopyrrolate (14 microg/kg). Anesthetized patients received an intubating dose of rocuronium (0.6 mg/kg), with maintenance doses (0.15 mg/kg) as required. Neuromuscular monitoring was performed by acceleromyography. Sugammadex or neostigmine was administered at reappearance of 1-2 posttetanic counts (profound neuromuscular blockade). The primary efficacy parameter was the time from sugammadex or neostigmine-glycopyrrolate administration to return of the train-of-four ratio to 0.9. Results In the intent-to-treat population (n = 37 in each group), geometric mean time to recovery to a train-of-four ratio of 0.9 with sugammadex was 2.9 min versus 50.4 min with neostigmine-glycopyrrolate (P &lt; 0.0001) (median, 2.7 min vs. 49.0 min). Most sugammadex patients (97%) recovered to a train-of-four ratio of 0.9 within 5 min after administration. In contrast, most neostigmine patients (73%) recovered between 30 and 60 min after administration, with 23% requiring more than 60 min to recover to a train-of-four ratio of 0.9. Conclusions Recovery from profound rocuronium-induced neuromuscular blockade was significantly faster with sugammadex versus with neostigmine, suggesting that sugammadex has a unique ability to rapidly reverse profound rocuronium neuromuscular blockade.

Delirium related distress in family: A non-systematic review

2016 ◽  
Vol 33 (S1) ◽  
pp. S187-S187
Author(s):  
S. Martins ◽  
L. Fernandes
Keyword(s):  
Systematic Review ◽  
Health Care Professionals ◽  
Family Members ◽  
Hospitalized Patients ◽  
Negative Consequences ◽  
Inclusion Criteria ◽  
Prospective Assessment ◽  
Competing Interest ◽  
Poor Functional Status ◽  
Elderly Hospitalized Patients

IntroductionDelirium is a common neuropsychiatric syndrome, particularly in elderly hospitalized patients, and is associated with an increase in morbidity and mortality. Although these negative consequences are well documented, only a few studies describe the experience of delirium from the families’ perspective.AimsTo analyze studies regarding the experience and distress caused by delirium in the families/caregivers of adult/elderly hospitalized patients.MethodsA non-systematic review of published articles until October 2015 in the database PubMed was carried out. The keyword “Delirium” was combined with: “experience”, “distress”, “anxiety” and “family”, “carer” and “relatives”. Inclusion criteria were: standardized diagnosis of delirium, systematic/prospective assessment of distress level. Clinical cases were excluded.ResultsSixteen studies met the inclusion criteria for analysis. In most of them, family members (mostly younger) showed high levels of distress, even higher than health care professionals and patients. Several predictors of family distress were found, including poor functional status, psychomotor agitation, delusions, emotional lability, incoherent speech, inattention and disorientation. Higher distress was associated with long-term consequences (e.g. generalized anxiety). In the qualitative research, family members interpreted delirium as a sign of approaching death, result of pain/discomfort or an effect of medication. In addition, distress was associated with rapid and unexpected changes or unable to recognize the loved ones.ConclusionsDelirium in patients was associated with significant distress in family members. These findings underline the importance of providing information and the development of appropriate supportive and psychoeducational interventions in order to help families throughout this process and reduce the associated distress. This work is supported by FCT (SFRH/BPD/103306/2014).Disclosure of interestThe authors have not supplied their declaration of competing interest.

Model for assigning security objects to a specific risk category in the field of fire safety

2020 ◽  
Vol 90 ◽  
pp. 19-31
Author(s):  
D. V. Zobkov ◽  
◽  
A. A. Poroshin ◽  
A. A. Kondashov ◽  
◽  
...  
Keyword(s):  
Adverse Effects ◽  
Fire Safety ◽  
Economic Activity ◽  
Fire Hazard ◽  
Risk Category ◽  
Negative Consequences ◽  
Acceptable Risk ◽  
Individual Object ◽  
Safety Requirements ◽  
Risk Categories

Introduction. A mathematical model is presented for assigning protection objects to certain risk categories in the field of fire safety. The model is based on the concepts of the probability of adverse effects of fires causing harm (damage) of various extent and severity to the life or health of citizens, and the acceptable risk of harm (damage) from fires. Goals and objectives. The purpose of the study is to develop the procedure for assigning protection objects to a certain category of risk of harm (damage) based on estimates of the probability of fires with the corresponding severity consequences, to determine the acceptable level of risk of harm (damage) due to the fires, to calculate and develop numerical values of criteria for assigning objects of protection to the appropriate risk categories. Methods. The boundaries of the intervals corresponding to certain risk categories are determined by dividing the logarithmic scale of severity of adverse effects of fires into equal segments. Classification methods are used to assign objects of protection to a specific risk category. Results and discussion. Based on the level of severity of potential negative consequences of a fire, risk categories were determined for groups of protection objects that are homogeneous by type of economic activity and by functional fire hazard classes. The risk category for each individual object of protection is proposed to be determined using the so-called index of "identification of a controlled person" within a group of objects that are homogeneous by type of economic activity and class of functional fire hazard. Depending on the risk category, the periodicity of planned control and supervision measures in relation to the specific object of protection under consideration is determined, taking into account its socio-economic characteristics and the state of compliance with fire safety requirements by the controlled person. Conclusions. To develop criteria for classifying protection objects that are homogeneous in terms of economic activity and functional fire hazard classes, the probability of negative consequences of fires, that are causing harm (damage) of various extent and severity to the life or health of citizens, and the acceptable risk of causing harm (damage) as a result of fires, is used. The risk category for each individual object of protection is determined taking into account socio-economic characteristics of the object that affect the level of ensuring its fire safety, as well as the criteriaof integrity of the subordinate person that characterize the probability of non-compliance with mandatory fire safety requirements at the object of protection. Calculations are made and numerical values of criteria for assigning protection objects that are homogeneous in terms of economic activity and functional fire hazard classes to a certain category of risk are proposed. Key words: object of protection, probability of fire, acceptable level of risk, risk category, dangerous factor of fire, death and injury of people.

Effective Parental intervention strategies to reduce screen time among preschool-aged children: A systematic review (Preprint)

2020 ◽  
Author(s):  
Diana Raj ◽  
Halimatus Sakdiah Minhat ◽  
Nor Afiah Mohd. Zulkefli ◽  
Norliza Ahmad
Keyword(s):  
Systematic Review ◽  
Preschool Children ◽  
Young Children ◽  
Screen Time ◽  
Mode Of Delivery ◽  
Intervention Strategies ◽  
Controlled Trials ◽  
Cochrane Central Register ◽  
Negative Consequences ◽  
Parental Intervention

BACKGROUND The increasing screen time exposure among young children in general and the reported negative consequences associated with excessive ST, calls for focused strategies to reduce ST, especially among young children. OBJECTIVE This systematic review aimed to identify effective parental intervention strategies to reduce ST among preschool children. METHODS A total of five databases, namely Cochrane Central Register of Controlled Trials, CINAHL, Medline Complete, PubMed, and Scopus, were searched for randomised controlled trials that involved intervention strategies in ST reduction among preschool children. PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines were used. RESULTS A total of nine studies were assessed. The results showed that besides providing knowledge and awareness regarding ST, having restrictive practices, offering alternative activities to parents, and removal of screen from child’s bedroom were the most common strategies used by studies that reported successful intervention. Intervention duration of between six to eight weeks was sufficient to produce ST reduction. Face-to-face method was the commonest mode of delivery. Theoretical constructs that aimed at increasing parental self-efficacy, listing outcome expectations, and offering reinforcement of strategies that targeted both the parents and home environment were beneficial in reducing ST. CONCLUSIONS By offering appropriate strategies to parents, a reduction in the amount of ST was observed among the children. Future intervention studies could benefit in exploring culturally adapted strategies, especially in developing countries. Trials of higher quality would also facilitate the drawing of conclusions in future research. CLINICALTRIAL PROSPERO No: CRD42020199398

scholarly journals Barriers to Incident Reporting among Nurses: A Qualitative Systematic Review

2021 ◽  
pp. 019394592199944
Author(s):  
Moataz Mohamed Maamoun Hamed ◽  
Stathis Konstantinidis
Keyword(s):  
Systematic Review ◽  
Methodological Quality ◽  
Incident Reporting ◽  
Negative Consequences ◽  
Incident Reporting Systems ◽  
Qualitative Systematic Review ◽  
Blame Culture ◽  
Critical Appraisal Skills ◽  
Definition Of

Incident reporting in health care prevents error recurrence, ultimately improving patient safety. A qualitative systematic review was conducted, aiming to identify barriers to incident reporting among nurses. Joanna Briggs Institute methodology for qualitative systematic reviews was followed, with data extracted using JBI QARI tools, and selected studies assessed for methodological quality using Critical Appraisal Skills Program (CASP). A meta-aggregation synthesis was carried out, and confidence in findings was assessed using GRADE ConQual. A total of 921 records were identified, but only five studies were included. The overall methodological quality of these studies was good and GRADE ConQual assessment score was “moderate.” Fear of negative consequences was the most cited barrier to nursing incident reporting. Barriers also included inadequate incident reporting systems and lack of interdisciplinary and interdepartmental cooperation. Lack of nurses’ necessary training made it more difficult to understand the importance of incident reporting and the definition of error. Lack of effective feedback and motivation and a pervasive blame culture were also identified.

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