Anaesthesia and intensive care
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Anaesth Intensive Care · Jul 2021
A survey of current management of neuromuscular block and reversal in Australia and New Zealand.
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. ⋯ 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.
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Anaesth Intensive Care · Jul 2021
ReviewAirway management in the adult patient with COVID-19: High flow nasal oxygen or not? A summary of evidence and local expert opinion.
The use of high flow nasal oxygen in the care of COVID-19-positive adult patients remains an area of contention. Early guidelines have discouraged the use of high flow nasal oxygen therapy in this setting due to the risk of viral spread to healthcare workers. However, there is the need to balance the relative risks of increased aerosol generation and virus transmission to healthcare workers against the role high flow nasal oxygen has in reducing hypoxaemia when managing the airway in high-risk patients during intubation or sedation procedures. ⋯ However, given the limited safety data, we recommend a cautious approach. For intubation in the COVID-positive or suspected COVID-positive patient we support the use of high flow nasal oxygen to extend time to desaturation in the at-risk groups, which include the morbidly obese, those with predicted difficult airways and patients with significant hypoxaemia, ensuring well-fitted high flow nasal oxygen prongs with staff wearing full personal protective equipment. For sedation cases, we support the use of high flow nasal oxygen when there is an elevated risk of hypoxaemia (e.g. bariatric endoscopy or prone-positioned procedures), but recommend securing the airway with a cuffed endotracheal tube for the longer duration procedures when theatre staff remain in close proximity to the upper airway, or considering the use of a surgical mask to reduce the risk of exhaled particle dispersion.