Browsing by Subject "Neuromuscular Blockade"
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Item The Invisible Force: Optimizing Novel Approaches in Anesthesiology and Infectious Diseases(2022-05-01T05:00:00.000Z) Vachon, Matthew Jonathan; Marull, Javier H.; Huth, James F.; Lin, MitchellThis work encompasses a theme revolving the OR: specifically, preoperatively, perioperatively, and postoperatively. Chapter 1 describes a novel method whereby biofilm is destroyed using Alternating Magnetic Fields (AMF). Using S. aureus grown on steel washers to simulate prosthetic joints, we were able to intermittently deliver 3s pulses for 15, 30, or 60 minutes to reduce bacterial load. Combined treatment with AMF and ceftriaxone (or linezolid) showed a 5-log decrease in bacterial load after 24 hours, whereas singular treatment with AMF or abx alone showed total regrowth or moderate decrease in bacterial load respectively. Chapter 2 describes a meta-analysis conducted to assess the safety and efficiency of sugammadex versus neostigmine as neuromuscular blockade (NMB) reversal agents. Neostigmine has been implemented in ORs for many years, but has disadvantages to using neostigmine including autonomic dysfunction like bradycardia and post-operative nausea & vomiting (PONV), and the necessity to administer the drug at the correct time due to its lag time in effect. Sugammadex appears to circumnavigate these problems, but the literature is still not definitive. We performed a meta-analysis that showed sugammadex as having a milder side effect profile compared to neostigmine with reduction in pneumonia (RR = 0.593, 95% CI (0.361, 0.671) and bradycardia (RR = 0. 535, 95% CI (0.424, 0.675), higher PONV risk (RR = 1.21, 95% CI (1.05, 1.39)), and with faster turnaround times. Chapter 3 describes a survey sent out to ambulatory surgical centers (ASC) on management of patients with obstructive sleep apnea (OSA). The need for a CPAP device in the immediate postoperative period at ambulatory surgical centers remains controversial because these ambulatory patients are healthier and have fewer complications. Only 59.7% of ASCs required their patients to bring their CPAP devices on the day of surgery, and 25.37% reported using a CPAP machine postoperatively within the past 2 years, with the highest CPAP usage at one facility being 20 times in that 2-year period. Studies further in-depth are necessary to assess postoperative complications that require a CPAP device to determine the urgency of ASCs implementing SAMBA's recommendations.Item Sugammadex versus Neostigmine for Reversal of Rocuronium-Induced Neuromuscular Blockade: A Study of Thoracic Surgical Patients(2019-01-22) Jan, Kathryn; Pak, Taylor; Smith, Katelynn; Somasundaram, Alwin; Moon, Tiffany SunBACKGROUND: Sugammadex is a novel agent for the reversal of neuromuscular paralysis. Neostigmine is more commonly used for reversal but is associated with side effects including bronchospasm, nausea/vomiting, hypotension, and bradycardia. While there has been anecdotal evidence that patients treated with sugammadex have better subjective measures of recovery compared to those treated with neostigmine, few studies have systematically evaluated this, especially in patients whose pre-existing pulmonary disease predisposes them to postoperative adverse respiratory events. The simultaneous evaluation of clinical outcomes, economic implications, and postoperative recovery quality could give evidence to support usage of a neuromuscular reversal agent with less side effects. HYPOTHESIS: In thoracic surgical patients, reversal with sugammadex as compared to neostigmine will result in less hypoxic episodes in the post-anesthesia care unit (PACU), improved postoperative recovery quality, and lower costs secondary to the faster reversal to extubation, reversal out of operating room (OR), and shorter PACU stay. METHODS: 100 adult patients undergoing thoracic surgery with general endotracheal anesthesia are enrolled into this double-blind study to evaluate three domains: physiological factors, nociceptive factors, and emotional factors. After obtaining baseline parameters, patients are randomized to one of two groups: one receiving 50mcg/kg, maximum 5mg of neostigmine mixed with 8mcg/kg, maximum of 1mg glycopyrrolate; the other receiving 2 mg/kg of sugammadex. Upon patient's PACU arrival, degree of neuromuscular function is assessed utilizing the TOF Watch accelerometer device, and parameters, including vitals, postoperative quality recovery scale (PQRS) assessment, adverse events, and drugs given, from the time the patient arrived in the PACU until discharge are observed and recorded. PRELIMINARY RESULTS: While approximately 81 patients have been enrolled so far, statistical analysis is pending more data collection; however, there appears to be two distinct groups, one of which has a significantly shorter reversal time as well as a shorter duration in the PACU than the other. It is predicted that those who receive sugammadex will experience better outcomes related to these factors. CONCLUSION: If there is a significant improvement as a result of sugammadex usage, a revision of current protocol for neuromuscular blockade reversal in thoracic surgical patients is recommended to improve patient outcomes and lower costs.