scholarly journals Sugammadex administration shortens reversal times but not operating room turnover times

2019 ◽  
Vol 5 (1) ◽  
pp. 27
Author(s):  
Garrett Enten ◽  
Michael Albrink ◽  
Jin Deng ◽  
Giorgio Melloni ◽  
Enrico M. Camporesi ◽  
...  
Keyword(s):  
Abdominal Surgery ◽  
Operating Room ◽  
Outcome Measures ◽  
The Other ◽  
Muscle Paralysis ◽  
Or Efficiency ◽  
Reversal Agents ◽  
Reversal Time ◽  
Train Of Four ◽  
Complete Reversal

Objective: Current literature debates whether administration of sugammadex translates into a higher operating room (OR) efficiency when compared to neostigmine. This study is a blinded assessment of the effects of sugammadex versus neostigmine on OR efficiency as determined by time of reversal to time of the next case.Methods: 50 patients undergoing abdominal surgery were randomized and evenly distributed into two groups, one receiving sugammadex (4 mg/kg) and the other, neostigmine (0.06 mg/kg) plus glycopyrrolate (0.004 mg/kg). Muscle paralysis was induced with intravenous rocuronium (0.6 mg/kg). Train of four (TOF) was monitored using acceleromyography every 10 minutes until reversal. Reversal agents were blindly prepared and administered during closing. TOF was then recorded every minute until a T4/T1 ratio ≥ 0.9 was achieved. This was designated as time of complete reversal. Subsequently, post-reversal outcome measures were collected.Results: Patients receiving sugammadex experienced a significantly shorter reversal time compared to those receiving neostigmine and glycopyrrolate (2.92 ± 1.71 minutes vs. 7.68 ± 5.63 minutes; p = .0002). No other outcome measures were significantly different between groups: time of OR ready for next case was 55.4 min vs. 56.1 min respectively; not significant.Conclusions: While sugammadex was significantly faster at reversing patient neuromuscular blockade the time from reversal to patient extubation after Sugammadex was prolonged. . This could be due to blinding, as blinded providers are unable to anticipate time of reversal and must compensate by making decisions at safe fixed intervals. This is reflected in that the time gained by administration of sugammadex is approximately equal to the delay experienced across all endpoints collected to the patients’ actual discharge.

scholarly journals Comparison of the Time to Extubation and Length of Stay in the PACU after Sugammadex and Neostigmine Use in Two Types of Surgery: A Monocentric Retrospective Analysis

2021 ◽  
Vol 10 (4) ◽  
pp. 815
Author(s):  
Cyrus Motamed ◽  
Jean Louis Bourgain
Keyword(s):  
Abdominal Surgery ◽  
Retrospective Analysis ◽  
Operating Room ◽  
Exit Time ◽  
Real Life ◽  
Pulmonary Complications ◽  
Recovery Unit ◽  
Extubation Time ◽  
Train Of Four ◽  
Pacu Stay

Sugammadex provides a rapid pharmacological reversal of aminosteroid, as well as fewer pulmonary complications, a better physiological recovery, and shorter stays in the postanesthetic recovery unit (PACU). This retrospective analysis of our Centricity anesthesia database in 2017–2019 assessed the efficiency of sugammadex in real-life situations in two groups of surgical cancer patients (breast and abdominal surgery) based on the extubation time, operating room exit time, and length of PACU stay. Overall, 382 anesthesia records (131 breast and 251 abdominal surgeries) were extracted for the pharmacological reversal of neuromuscular blockades by neostigmine or sugammadex. Sugammadex was used for reversal in 91 breast and 204 abdominal surgeries. Sugammadex use did not affect the extubation time, operating room exit time, or length of PACU stay. However, the time to reach a 90% train of four (TOF) recovery was significantly faster in sugammadex patients: 2 min (1.5–8) in breast surgery and 2 min (1.5–7) in abdominal surgery versus 10 (6–20) and 9 min (5–20), respectively, for neostigmine (p < 0.05). Most patients who were reversed with sugammadex (91%) reached a TOF ratio of at least 90%, while 54% of neostigmine patients had a 90% TOF ratio recorded (p < 0.05). Factors other than pharmacological reversal probably influence the extubation time, operating room exit time, or PACU stay; however, sugammadex reliably shortened the time so as to reach a 90% TOF ratio with a better level of reversal.

scholarly journals STUDIES ON SALT ACTION

1925 ◽  
Vol 9 (2) ◽  
pp. 123-136
Author(s):  
Howard J. Shaughnessy ◽  
Katharine I. Criswell
Keyword(s):  
Alkaline Solution ◽  
Prolonged Exposure ◽  
Sharp Decrease ◽  
Migration Velocity ◽  
The Other ◽  
Distilled Water ◽  
Solution Ph ◽  
Complete Reversal ◽  
Locke Solution ◽  
Optimum Reaction

1. The strain of Bacterium coli used in these experiments multiplies in distilled water at pH 6.0 and pH 8.0 and in Ringer-Locke solution at pH 6.0. Under all the other conditions studied the numbers decrease with the passage of time. 2. The electrophoretic charge of the cells is highest in distilled water at pH 6.0 and pH 8.0. Under all other conditions studied the velocity of migration is decreased, but the decrease is immediate and is not affected by more prolonged exposure. 3. A strongly acid solution (pH 2.0) causes a rapid death of the cells and a sharp decrease in electrophoretic charge, sometimes leading to complete reversal. 4. A strongly alkaline solution (pH 11.0) is almost as toxic as a strongly acid one, although in distilled water the organisms survive fairly well at this reaction. Electrophoretic charge, on the other hand, is only slightly reduced in such an alkaline medium. 5. In distilled water, reactions near the neutral point are about equally favorable to both viability and electrophoretic charge, pH 8.0 showing slightly greater multiplication and a slightly higher charge than pH 11.0. In the presence of salts, however, pH 8.0 is much less favorable to viability and somewhat more favorable to electrophoretic charge than is pH 6.0. 6. Sodium chloride solutions, in the concentrations studied, all proved somewhat toxic and all tended to depress electrophoretic charge. Very marked toxicity was, however, exhibited only in a concentration of .725 M strength or over and at pH 8.0, while electrophoretic migration velocity was only slightly decreased at a concentration of .0145 M strength. 7. Calcium chloride was more toxic than NaCl, showing very marked effects in .145 M strength at pH 8.0 and in 1.45 M strength at pH 6.0. It greatly depressed electrophoretic charge even in .0145 M concentration. 8. Ringer-Locke solution proved markedly stimulating to the growth of the bacteria at pH 6.0 while at pH 8.0 it was somewhat toxic, though less so than the solutions of pure salts. It depressed migration velocity at all pH values, being more effective than NaCl in this respect, but less effective than CaCl2. 9. It would appear from these experiments that a balanced salt solution (Ringer-Locke's) may be distinctly favorable to bacterial viability in water at an optimum reaction while distinctly unfavorable in a slightly more alkaline solution. 10. Finally, while there is a certain parallelism between the influence of electrolytes upon viability and upon electrophoretic charge, the parallelism is not a close one and the two effects seem on the whole to follow entirely different laws.

Telemedicine for New Neurological Outpatients: Putting a Randomized Controlled Trial in the Context of Everyday Practice

2002 ◽  
Vol 8 (5) ◽  
pp. 270-273 ◽  
Author(s):  
Richard Chua ◽  
John Craig ◽  
Thomas Esmonde ◽  
Richard Wootton ◽  
Victor Patterson
Keyword(s):  
Randomized Controlled Trial ◽  
Outcome Measures ◽  
Retrospective Review ◽  
Controlled Trial ◽  
The Other ◽  
Everyday Practice ◽  
General Hospitals ◽  
Face To Face ◽  
Randomized Controlled ◽  
General Physicians

In a retrospective review, the telemedical management of 65 outpatients from a randomized controlled trial (RCT) of telemedicine for non-urgent referrals to a consultant neurologist was compared with the management of 76 patients seen face to face in the same trial, with that of 150 outpatients seen in the neurology clinics of district general hospitals and with that of 102 neurological outpatients seen by general physicians. Outcome measures were the numbers of investigations and of patient reviews. The telemedicine group did not differ significantly from the 150 patients seen face to face by neurologists in hospital clinics in terms of either the number of investigations or the number of reviews they received. Patients from the RCT seen face to face had significantly fewer investigations but a similar number of reviews to the other 150 patients seen face to face by neurologists (the disparity in the number of investigations may explain the negative result for telemedicine in that RCT). Patients with neurological symptoms assessed by general physicians had significantly more investigations and were reviewed significantly more often than all the other groups. Patients from the RCT seen by telemedicine were not managed significantly differently from those seen face to face by neurologists in hospital clinics but had significantly fewer investigations and follow-ups than those patients managed by general physicians. The results suggest that management of new neurological outpatients by neurologists using telemedicine is similar to that by neurologists using a face-to-face consultation, and is more efficient than management by general physicians.

Feed Abdominal Surgery Patients to Improve Outcomes

2021 ◽  
Vol 66 (6) ◽  
pp. 158-160
Author(s):  
Laura Bolton
Keyword(s):  
Abdominal Surgery ◽  
Clinical Outcomes ◽  
Postoperative Morbidity ◽  
Oral Feeding ◽  
The Other ◽  
Surgical Patients ◽  
Electrolyte Balance ◽  
Considerable Research ◽  
Balance Energy ◽  
The Subject

Malnourishment of surgical patients has long been recognized as contributing to postoperative morbidity and mortality.1,2 Early protocols calling for lengthy perioperative patient fasting have been replaced by interventions aimed at diagnosing and addressing each patient’s nutritional and metabolic needs; maintaining fluid and electrolyte balance, energy, and protein stores; and preserving muscle strength and gut microbiome by restoring oral feeding as soon as possible postoperatively.3 Interventions to achieve this physiologic balance have been the subject of considerable research, yet neither comprehensive preoperative programs4 nor early postoperative oral feeding5 have been reported to result in consistently improved clinical outcomes following abdominal surgery. This installment of Evidence Corner explores 2 systematic reviews, one of which presents clinical outcomes of early resumption of enteral food intake within 24 hours after gastrointestinal (GI) surgery,6 and the other presents clinical outcomes of perioperatively enhanced nutrition for those undergoing radical cystectomy (RC) for bladder cancer.7

scholarly journals What do double-check routines actually detect? An observational assessment and qualitative analysis of identified inconsistencies

BMJ Open ◽  
2020 ◽  
Vol 10 (9) ◽  
pp. e039291
Author(s):  
Yvonne Pfeiffer ◽  
Chantal Zimmermann ◽  
David L. B. Schwappach
Keyword(s):  
Qualitative Analysis ◽  
Outcome Measures ◽  
Medication Errors ◽  
The Other ◽  
Observational Assessment ◽  
Drug Label ◽  
Category System ◽  
Medication Process ◽  
Corrective Actions

ObjectivesDouble checking is used in oncology to detect medication errors before administering chemotherapy. The objectives of the study were to determine the frequency of detected potential medication errors, i.e., mismatching information, and to better understand the nature of these inconsistencies.DesignIn observing checking procedures, field noteswere taken of all inconsistencies that nurses identified during double checking the order against the prepared chemotherapy.SettingOncological wards and ambulatory infusion centres of three Swiss hospitals.ParticipantsNurses’ double checking was observed.Outcome measuresIn a qualitative analysis, (1) a category system for the inconsistencies was developed and (2) independently applied by two researchers.ResultsIn 22 (3.2%) of 690 observed double checks, 28 chemotherapy-related inconsistencies were detected. Half of them related to non-matching information between order and drug label, while the other half was identified because the nurses used their own knowledge. 75% of the inconsistencies could be traced back to inappropriate orders, and the inconsistencies led to 33 subsequent or corrective actions.ConclusionsIn double check situations, the plausibility of the medication is often reviewed. Additionally, they serve as a correction for errors and that are made much earlier in the medication process, during order. Both results open up new opportunities for improving the medication process.

Hospital-Acquired Myiasis

1980 ◽  
Vol 1 (5) ◽  
pp. 319-320 ◽  
Author(s):  
Jay A. Jacobson ◽  
Robert L. Kolts ◽  
Marlyn Conti ◽  
John P. Burke
Keyword(s):  
Infection Control ◽  
Thoracic Surgery ◽  
Operating Room ◽  
The Other ◽  
Tissue Destruction ◽  
Access Site ◽  
Control Programs ◽  
Hospital Acquired ◽  
Unusual Problem ◽  
Environmental Access

AbstractIn three years we encountered two patients with hospital-acquired myiasis, a rarely reported nosocomial problem. Both patients were elderly and had lengthy thoracic surgery in August in the same operating room. Larvae removed from the nares of one patient and from the chest incision of the other were of the same species, Phaenicia serricata. There was no evidence of tissue destruction or invasion in either case. Investigation revealed several factors that contributed to the presence of flies in the operating room. After a presumed environmental access site was closed and insecticide spraying was augmented, no additional cases occurred. This experience illustrates an unusual problem that may confront those responsible for infection control programs.

An Approach to a Science of Administration

1940 ◽  
Vol 34 (6) ◽  
pp. 1124-1137 ◽  
Author(s):  
Edwin O. Stene
Keyword(s):  
Public Administration ◽  
Scientific Method ◽  
The Other ◽  
Trial And Error ◽  
Field Of Study ◽  
Value Judgments ◽  
Or Efficiency ◽  
Scientific Principles ◽  
Scientific Terms ◽  
Scientific Value

Writers on public administration place much emphasis upon the possibilities and importance of discovering and applying scientific principles in their field of study. But very few of them have ventured to state the basic premises upon which they seek to build that science. Many of those whose writings imply that major principles have been discovered announce, not premises, but conclusions, which, regardless of their practical merits, can hardly be called anything but opinions. On the other hand, several scholars seek to escape from errors of commission by avoiding the use of such scientific terms as “principles” or “efficiency.” If they go beyond descriptive analyses to advocate particular plans of organization or methods of procedure, they use terms which denote value judgments, thereby admitting by implication that they are expressing mere opinions. In a few published discourses, basic premises are stated and reasoning is developed therefrom. However, most of those premises—or “principles”—are referred to by name only, such as “the principle of leadership”; they are not stated in terms of precise causal relations which can be verified or which can serve adequately as bases for further reasoning.It may be regarded as unwise to venture a statement of what one considers the basic premises upon which a science of administration may be built. But every body of theory is built upon fundamental assumptions, either expressed or implied. Moreover, a body of theory is complete, and has scientific value, only when the premises are sufficiently clear to permit objective scrutiny and verification. Erroneous hypotheses, stated precisely, may be more scientific than vague or unexpressed assumptions; for only the former will lend themselves to verification. In other words, trial and error is an essential part of scientific method.

Improving operating room productivity via parallel anesthesia processing

2014 ◽  
Vol 27 (8) ◽  
pp. 697-706 ◽  
Author(s):  
Michael J. Brown ◽  
Arun Subramanian ◽  
Timothy B. Curry ◽  
Daryl J. Kor ◽  
Steven L. Moran ◽  
...  
Keyword(s):  
Parallel Processing ◽  
Operating Room ◽  
Upper Extremity ◽  
Regional Anesthesia ◽  
Practice Change ◽  
Care Providers ◽  
Processing Efficiency ◽  
Or Efficiency ◽  
Content Type ◽  
Efficiency And Productivity

Purpose – Parallel processing of regional anesthesia may improve operating room (OR) efficiency in patients undergoes upper extremity surgical procedures. The purpose of this paper is to evaluate whether performing regional anesthesia outside the OR in parallel increases total cases per day, improve efficiency and productivity. Design/methodology/approach – Data from all adult patients who underwent regional anesthesia as their primary anesthetic for upper extremity surgery over a one-year period were used to develop a simulation model. The model evaluated pure operating modes of regional anesthesia performed within and outside the OR in a parallel manner. The scenarios were used to evaluate how many surgeries could be completed in a standard work day (555 minutes) and assuming a standard three cases per day, what was the predicted end-of-day time overtime. Findings – Modeling results show that parallel processing of regional anesthesia increases the average cases per day for all surgeons included in the study. The average increase was 0.42 surgeries per day. Where it was assumed that three cases per day would be performed by all surgeons, the days going to overtime was reduced by 43 percent with parallel block. The overtime with parallel anesthesia was also projected to be 40 minutes less per day per surgeon. Research limitations/implications – Key limitations include the assumption that all cases used regional anesthesia in the comparisons. Many days may have both regional and general anesthesia. Also, as a case study, single-center research may limit generalizability. Practical implications – Perioperative care providers should consider parallel administration of regional anesthesia where there is a desire to increase daily upper extremity surgical case capacity. Where there are sufficient resources to do parallel anesthesia processing, efficiency and productivity can be significantly improved. Originality/value – Simulation modeling can be an effective tool to show practice change effects at a system-wide level.

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