Preferences of Mexican anesthesiologists for vecuronium, rocuronium, or other neuromuscular blocking agents: a survey

Nava-Ocampo, Alejandro A; Ramírez-Mora, Juan Carlos; Moyao‐García, Diana; Garduño-Espinosa, J; Salmerón, Jorge

doi:10.1186/1471-2253-2-2

Cited by 18 publications

(25 citation statements)

References 20 publications

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“…The routine use of neuromuscular instrumental monitoring varies among the European,[14] Italian,[7] Denmark,[15] Middle Eastern, Germany,[16] American,[14] United Kingdom,[17] and Mexico[18] anesthesiologists (70.2%, 50%, 43%, 35%, 28%, 22.7%, 10%, and 2% of the respondents, respectively).…”

Section: Discussionmentioning

confidence: 99%

A survey of the current use of neuromuscular blocking drugs among the Middle Eastern anesthesiologists

Eldawlatly

El-Tahan

2013

Saudi J Anaesth

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Background:This survey aimed to assess the extent of practice of the Middle Eastern anesthesiologists in the use of neuromuscular blocking agents (NMB) in 2012.Methods:We distributed an electronic survey among 577 members of the Triple-M Middle Eastern Yahoo anesthesia group, enquiring about their practice in the use of neuromuscular blocking agents. Questions concerned the routine first choice use of NMB, choice for tracheal intubation, the use of neuromuscular monitoring (NMT), type of NMB used in difficult airway, frequency of using suxamethonium, cisatracurium, rocuronium and sugammadex, observed side effects of rocuronium, residual curarization, and the reversal of residual curarization of rocuronium.Results:A total of 71 responses from 22 Middle Eastern institutions were collected. Most of the Middle Eastern anesthesiologists were using cisatracurium and rocuronium frequently for tracheal intubation (39% and 35%, respectively). From the respondents, 2/3 were using suxamethonium for tracheal intubation in difficult airway, 1/3 were using rocuronium routinely and 17% have observed hypersensitivity reactions to rocuronium, 54% reported residual curarization from rocuronium, 78% were routinely using neostigmine to reverse the rocuronium, 21% used sugammadex occasionally, and 35% were using NMT routinely during the use of NMB.Conclusions:We believe that more could be done to increase the awareness of the Middle Eastern anesthesiologists about the high incidence of PROC (>20%) and the need for routine monitoring of neuromuscular function. This could be accomplished with by developing formal training programs and providing official guidelines.

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Section: Discussionmentioning

confidence: 99%

A survey of the current use of neuromuscular blocking drugs among the Middle Eastern anesthesiologists

Eldawlatly

El-Tahan

2013

Saudi J Anaesth

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“…Because approximately four million surgical procedures are performed each year (Fox‐Quesada V. Desarrollo social y Humano–Salud (Equidad); http://informe.presidencia.gob.mx/informes/2001Fox1), this may result in a significant disadvantage if rocuronium is used in all the anaesthetic procedures requiring an NBA. In fact, Mexican anaesthesiologists are still using vecuronium for most anaesthetic procedures requiring tracheal intubation, whereas rocuronium is reserved for tracheal intubation in patients with, for example, a full stomach 2 . However, an evaluation of cost was only intentionally considered in one of the clinical trials that compared rocuronium with rocuronium 3 .…”

Section: Discussionmentioning

confidence: 99%

“…However, of the known NBA, rocuronium has a moderate propensity to cause allergy 1 and was temporarily withdrawn from routine practice in Norway because of an increase in the reporting of anaphylactic reactions (The Norwegian Medicines Agency; http://www.legemiddelverket.no/bivirk/prepfok/esmeron.htm). In Mexico, rocuronium costs more than vecuronium and, therefore, its routine use for the tracheal intubation of patients undergoing surgical procedures may present a significant budgetary constraint if it is to be used in massive public health‐care services 2 …”

Section: Introductionmentioning

confidence: 99%

Meta‐analysis of the Differences in the Time to Onset of Action Between Rocuronium and Vecuronium

Nava-Ocampo

Velázquez-Armenta

Moyao‐García

et al. 2006

Clin Exp Pharma Physio

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1. The aim of the present study was to conduct a meta-analysis of the magnitude of differences in the onset of action (T(max)) between rocuronium and vecuronium. 2. A search was made in PubMed, EMBASE Drugs and Pharmacology, Cochrane Controlled Trials Register and Cochrane Database on Systematic Reviews. Studies comparing the T(max) at the adductor policies between rocuronium and vecuronium administered as an intravenous bolus were included in the study. Twenty-nine effect sizes obtained from 21 studies were included. 3. The result of the meta-analysis of differences was -57.9 s (95% confidence interval -71.4 to -44.3 s), favouring rocuronium over vecuronium. The smallest difference in T(max) between these neuromuscular-blocking agents was observed in children (-19.1 s). The difference in T(max) between rocuronium and vecuronium in female patients was -38.7 s. The difference in T(max) between rocuronium and vecuronium measured by electromyography was approximately 50% shorter than that determined by acceleromyography or mechanomyography. In a subanalysis between rocuronium 600 mg/kg versus vecuronium 100 mg/kg, the difference in T(max) between them was very similar to that obtained in the general meta-analysis. 4. According to subanalyses of patient age and sex, drug dose and neuromuscular monitoring systems, the T(max) of rocuronium was approximately 20-70 s faster than that of vecuronium.

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“…For example, in Mexico, rocuronium is substantially more expensive than vecuronium while in Canada they are very similar. Mivacurium, a short‐acting neuromuscular blocking agent that may be used for short anesthetic procedures reducing costs of recovery times longer than those required for short procedures, is not longer available in Mexico [7].…”

Section: Discussionmentioning

confidence: 99%

“…The hospital annually receives a fixed budget, and an additional budget can only rarely be obtained during this period. Unfortunately, the cost of drugs is not yet a concern among Mexican colleagues [6,7]. Furthermore, the drug acquisition and distribution systems at HIM are favouring that drugs with low cost‐effectiveness ratio or not yet approved for children, e.g.…”

Section: Introductionmentioning

confidence: 99%

Undocumented drug utilization and drug waste increase costs of pediatric anesthesia care

Nava-Ocampo

Alarcón-Almanza

Moyao‐García

et al. 2004

Fundamemntal Clinical Pharma

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The present study was performed in order to identify the cost of drugs used without documenting them in the patients' file and the wastage of drugs in a pediatric anesthesiology ward. In a prospective, blinded, observational design, drug utilization of 610 consecutive patients, undergoing an elective or emergency surgical procedure was evaluated. The number of undocumented drugs per 100 requested units and the number of wasted drugs per 100 requested units were computed and multiplied by its corresponding unitary cost. The median undocumented cost was 92.4 US dollars (95% CI 17.2-216.6 dollars) per 100 requested units. Succinylcholine (40 mg/2 mL) was the main undocumented drug; its use was not documented in approximately 50% cases in which this neuromuscular blocking agent was requested. However, rocuronium and nalbuphine had the highest unjustified cost, 770.6 dollars and 847.0 dollars per 100 requested units, respectively. Ketorolac, diclofenac, metamizol, furosemide, methylprednisolone, sodium bicarbonate, and cisatracurium were requested and documented. The median cost of wasted drug was 141.8 dollars (95% CI 55.8-448.2 dollars) per 100 requested drugs. More than 80% of adrenaline, naloxone, flunitrazepam, ephedrine, and cisatracurium were wasted. However, the highest cost of wasted drugs was for ondansetron, cisatracurium, methylprednisolone, and rocuronium. The uncontrolled availability and use of drugs may represent an important amount of resources wasted without any awareness of the staff in a department of pediatric anesthesia.

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Preferences of Mexican anesthesiologists for vecuronium, rocuronium, or other neuromuscular blocking agents: a survey

Abstract: Background: Several neuromuscular blocking (NMB) agents are available for clinical use in anesthesia. The present study was performed in order to identify preferences and behaviors of anesthesiologists for using vecuronium, rocuronium or other NMB agents in their clinical practice.

Cited by 18 publications

References 20 publications

A survey of the current use of neuromuscular blocking drugs among the Middle Eastern anesthesiologists

A survey of the current use of neuromuscular blocking drugs among the Middle Eastern anesthesiologists

Meta‐analysis of the Differences in the Time to Onset of Action Between Rocuronium and Vecuronium

Undocumented drug utilization and drug waste increase costs of pediatric anesthesia care

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