Implications of the 2015 <scp>AAGBI</scp> recommendations for standards of monitoring during anaesthesia and recovery

Checketts, M. R.; Jenkins, B. J.; Pandit, J. J.

doi:10.1111/anae.13736

Cited by 29 publications

(6 citation statements)

References 24 publications

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“…Currently, healthcare providers frequently monitor internal pressure of standard TT cuffs, as recommended by various clinical practice guidelines . In our current study, we found that the novel cuff had very low compliance, which is common in cuffs made of silicone , but the main drawback is that the internal pressure does not reflect the pressure transmitted against the tracheal wall and even slight increases in inflation volumes could double the transmitted tracheal pressure (Figs.…”

Section: Discussionmentioning

confidence: 63%

In‐vitro analysis of a novel ‘add‐on’ silicone cuff to improve sealing properties of tracheal tubes

et al. 2018

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Summary Leakage of colonised oropharyngeal secretions across the tracheal tube cuff may cause iatrogenic pulmonary infection. We studied a novel ‘add‐on’ cuff, which can be inserted over an existing tracheal tube and advanced into the subglottic region. The physical properties of the novel silicone cuff (BronchoGuard, Ciel Medical, USA) were evaluated in comparison with the Hi‐Lo® tracheal tube. In a bench study, we identified saline inflation volumes required to transmit pressures between 15 and 30 cmH2O against artificial tracheas of 18, 20 and 22 mm internal diameter. We computed cuff compliance, and minimal inflation volume to achieve air sealing during mechanical ventilation. Finally, we compared the leakage flow rate of artificial saliva across the novel cuff. On average, the mean (SD) inflation volumes necessary to transmit tracheal pressures of 15, 20, 25 and 30 cmH2O were 4.1 (2.2), 4.4 (2.3), 4.6 (2.4) and 4.8 (2.4) ml for the novel cuff and 7.7 (2.5), 8.0 (2.6), 8.4 (2.6) and 8.7 (2.7) ml for the Hi‐Lo tube, respectively (p < 0.001). The minimal inflation volumes to achieve air sealing were 3.8 (0.9) and 10.5 (2.1) ml (p < 0.001), which resulted in transmitted tracheal pressures of 8.3 (9.8) and 27.6 (34.8) cmH2O (p < 0.001). Compliance was 0.026 (0.004) and 0.616 (0.324) ml.cmH20−1, respectively (p < 0.001). Although massive leak was found when the novel cuff transmitted pressures ≤ 20 cmH2O against the trachea, leakage was avoided with pressures ≥ 25 cmH2O, owing to optimal contact between the cuff and the tracheal wall. In contrast, the standard cuff consistently leaked irrespective of the pressure. We conclude that the novel cuff has advantageous properties that warrant clinical corroboration.

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Section: Discussionmentioning

confidence: 63%

In‐vitro analysis of a novel ‘add‐on’ silicone cuff to improve sealing properties of tracheal tubes

et al. 2018

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“…A set of recommendations published by a world respected authority in anesthesia states that the use of neuromuscular monitoring, along with other standards, will lead to a reduction in adverse events and improve patient safety. Furthermore, they clarify that the use of neuromuscular monitoring in our profession is still too low, and remind us that clinical assessment alone of the offset of neuromuscular paralytic drugs is inadequate [1]. We believe perioperative neuromuscular monitoring to be mandatory for those patients who receive neuromuscular paralytic drugs.…”

Section: Discussionmentioning

confidence: 97%

Mivacurium, Fixation Error and Human Factors

Alibhai¹

2017

ACC

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We acknowledge the widely known subject area of mivacurium sensitivity, but we would like to present this case to highlight human factors that led us to incorrectly believe that spontaneous neuromuscular recovery had already occurred. There is now a wealth of information in current speciality and non-speciality specific literature that enforces our understanding of the importance of human factors in the outcome of both crisis and non-crisis situations. The subject area of human factors is growing,

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“…Errando et al [19] reported that 26.7% of patients had PORC after the use of a non-depolarising neuro-muscular blocker. The fifth edition of the Association of Anesthetists of Great Britain and Ireland standards of monitoring was indicated that monitoring of neuromuscular blocking agents was mandatory [20] . Arbous et al [21] observed a significant decrease in PORC when monitoring muscle relaxation in the operating room and using reversal agents.…”

Section: Discussionmentioning

confidence: 99%

Reversal of rocuronium induced neuromuscular blockade in lung resection surgery: a comparison of sugammadex and neostigmine

Çitil¹,

Tuncel²,

Yapıcı³

et al. 2019

GKDA Derg

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Introduction: The aim of this study was to compare sugammadex and neostigmine in terms of reversing time, recovery time and extubation time in reversal of rocuronium-induced neuromuscular block in patients undergoing lung resection surgery. Method: A total of 60 patients under 75 years of age with an ASA status of II-III undergoing elective pulmonary resection (lobectomy, pneumectomy, wedge resection) who had adequate left ventricle function (EF >40%), normal renal, hepatic, and mental functions, were included in this study Patients were assigned into neostigmine (Group N, n=30) and sugammadex (Grup S, n=30) groups. Results: Time from starting of neuromuscular blockade reversing agent till reaching TOF>0.9 was significantly shorter in Group S (p=0.001). Similarly, extubation time and recovery time were significantly shorter in Group S (p=0.05; p=0.012, respectively). No statistically significant differences were observed between the two groups in terms of the operation time and duration of ICU stay. Postoperative complications were similar in both groups. Postoperative residual curarisation was not observed in both groups. Conclusion: In lung resection surgery, sugammadex appears to be a superior selective relaxant binding agent as compared to neostigmine in the reversal of rocuronium-induced neuromuscular block with earlier recovery and earlier achievement of TOF ratio of 0.9.

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Implications of the 2015 AAGBI recommendations for standards of monitoring during anaesthesia and recovery

Cited by 29 publications

References 24 publications

In‐vitro analysis of a novel ‘add‐on’ silicone cuff to improve sealing properties of tracheal tubes

In‐vitro analysis of a novel ‘add‐on’ silicone cuff to improve sealing properties of tracheal tubes

Mivacurium, Fixation Error and Human Factors

Reversal of rocuronium induced neuromuscular blockade in lung resection surgery: a comparison of sugammadex and neostigmine

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