British journal of anaesthesia
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Multicenter Study
Association of sugammadex reversal of neuromuscular block and postoperative length of stay in the ambulatory care facility: a multicentre hospital registry study.
Encapsulation of rocuronium or vecuronium with sugammadex can reverse neuromuscular block faster than neostigmine reversal. This pharmacodynamic profile might facilitate patient discharge after ambulatory surgery. ⋯ Reversal with sugammadex compared with neostigmine was associated with a small decrease in postoperative length of stay in the ambulatory care unit. The effect was magnified in older and high-risk patients, and can be explained by reduced postoperative nausea and vomiting. Sugammadex reversal in ambulatory surgery may also help reduce cost of care.
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Auditory interfaces play a vital role in many applications, informing users about both urgent and routine information critical to safety. Unfortunately, problems related to high alarm rates, low reliability, and sound annoyance create barriers to optimising the quality of patient care in perioperative medicine and critical care. Here, we explore how to reduce annoyance and improve detection by manipulating a sound's temporal envelope or the way its energy changes over time. ⋯ Temporal variation in amplitude envelope represents a promising path towards improving auditory interfaces for patient monitoring. By using temporally variable sounds, auditory interfaces can be more effective in alerting users. This is important for safety-critical areas, such as medical alarms, where annoyance often limits efficacy. As this manipulation can preserve the pitch and rhythm of tone sequences, it is compatible with users' pre-existing knowledge of current alarms.
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Preclinical studies have indicated that anaesthesia is an independent risk factor for dementia, but the clinical associations between dementia and different types of general anaesthesia or regional anaesthesia remain unclear. We conducted a population-based cohort study using propensity-score matching to compare dementia incidence in patients included in the Taiwanese National Health Insurance Research Database who received various anaesthetic types for hip fracture surgery. ⋯ The incidence rate ratios of dementia amongst older adults undergoing hip fracture surgery were higher for those receiving general anaesthesia than for those receiving regional anaesthesia, with inhalational anaesthesia associated with a higher incidence rate ratio for dementia than total intravenous anaesthesia (TIVA).
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Anaesthetic procedures are complex and subject to human error. Interventions to alleviate medication errors include organised syringe storage trays, but no standardised methods for drug storage have yet been widely implemented. ⋯ Colour-coded compartmentalisation enhanced visual search efficacy of pre-loaded trays. Reduced fixations and fixation times for the loaded tray were shown for colour-coded compartmentalised trays, indicating a reduction in cognitive load. Overall, colour-coded compartmentalised trays were associated with significant performance improvements when compared with conventional trays.