Can sugammadex save a patient in a simulated ‘cannot intubate, cannot ventilate’ situation?
2011; Wiley; Volume: 66; Issue: 3 Linguagem: Inglês
10.1111/j.1365-2044.2011.06643.x
ISSN1365-2044
AutoresSimon Mercer, Michael Moneypenny,
Tópico(s)Cardiac, Anesthesia and Surgical Outcomes
ResumoAnaesthesiaVolume 66, Issue 3 p. 223-224 Free Access Can sugammadex save a patient in a simulated ‘cannot intubate, cannot ventilate’ situation? S. J. Mercer, S. J. Mercer University Hospital Aintree, Liverpool, UK Email: simonjmer@hotmail.comSearch for more papers by this authorM. J. Moneypenny, M. J. Moneypenny University Hospital Aintree, Liverpool, UK Email: simonjmer@hotmail.comSearch for more papers by this author S. J. Mercer, S. J. Mercer University Hospital Aintree, Liverpool, UK Email: simonjmer@hotmail.comSearch for more papers by this authorM. J. Moneypenny, M. J. Moneypenny University Hospital Aintree, Liverpool, UK Email: simonjmer@hotmail.comSearch for more papers by this author First published: 14 February 2011 https://doi.org/10.1111/j.1365-2044.2011.06643.xCitations: 4 A response to a previously published article or letter can be submitted to the Online Correspondence section at http://www.anaesthesiacorrespondence.com. Please note that a selection of this correspondence will be reproduced (possibly in modified form) in the journal. All correspondence intended for publication in Anaesthesia should be addressed to Dr Steve Yentis, Editor-in-Chief, and submitted as an email attachment to anaesthesia@aagbi.org. Copy should be prepared in the usual style of the Correspondence section. Authors must follow the advice about references and other matters contained in the Guidance for Authors at http://wileyonlinelibrary.com/journal/anae. Correspondence presented in any other style or format will be returned to the author for revision. All correspondence submissions should be accompanied by a completed Author Declaration Form which can be accessed via a link under ‘Covering letter’ in the Guidance for Authors (as above). The completed Author Declaration Form should be sent either by e-mail with the submission or by fax to (0)207 681 1008. Visit the Anaesthesia Correspondence website at http://www.anaesthesiacorrespondence.com and comment on any article or letter in this issue of the Journal. AboutSectionsPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat We read with interest the recent article by Bisschops et al. evaluating the use of sugammadex in a simulated emergency scenario [1]. It is well known that simulation used in this type of setting allows the educator to set the clinical agenda and practise rare scenarios that may be predicted to happen during regular clinical practice [2]. Simulation is invaluable in testing and improving standard operating procedures [3] in a safe environment [4]. Familiarisation with environment and standard operating procedures is also vital in the use of non-technical skills [5], particularly when using a new drug such as sugammadex. In our experience, requiring candidates to draw up their own drugs in real-time, such as dantrolene in a scenario involving malignant hyperthermia, supports the learning objectives by enhancing realism and providing time-sensitive goals. We strongly agree with the recommendations made for the use of high-dose rocuronium in combination with sugammadex for rapid sequence induction and would like to suggest some steps based on our own experience. The first step we suggest is to brief the team that rocuronium is to be used and that should an unanticipated difficult airway situation be encountered, then sugammadex will be used to reverse the effects of the rocuronium. This briefing could be included as part of the World Health Organization checklist, where anticipated airway problems are discussed [6]. The second step is to allocate the task of drawing up the sugammadex to a specific team member who has no additional role in the rapid sequence induction. Before induction, a calculation is made of the dose of sugammadex (16 mg.kg−1) that would be required and the volume of drug that should be drawn up. The instruction is given that should the anaesthetist not confirm intubation within 2 min, then the sugammadex is to be drawn up and handed to the anaesthetist for administration. Tasking one person with the responsibility of drawing up this emergency drug in a timely manner may avoid any loss of situational awareness, which may arise when dealing with a difficult airway. This has occurred in high-profile cases [7] and we suggest that patient safety would be improved by the introduction of this additional anticipation and planning. No external funding and no competing interests declared. Previously posted at the Anaesthesia Correspondence website: http://www.anaesthesiacorrespondence.com. References 1 Bisschops MMA, Holleman C, Huitink JM. Can sugammadex save a patient in a simulated ‘cannot intubate, cannot ventilate’ situation? Anaesthesia 2010; 65: 936– 41. Wiley Online LibraryCASPubMedWeb of Science®Google Scholar 2 Cumin D, Merry AF, Weller JM. Standards for simulation. Anaesthesia 2008; 63: 1281– 7. Wiley Online LibraryCASPubMedWeb of Science®Google Scholar 3 Rall M, Dieckmann P. Simulation and patient safety: the use of simulation to enhance patient safety on a systems level. Current Anaesthesia and Critical Care 2005; 16: 273– 81. CrossrefGoogle Scholar 4 Glavin R. Simulation in anesthesia and acute care settings. European Journal of Anaesthesiology 2005; 22: 1– 222. Google Scholar 5 Rall M, Gaba D, Howard SK, Dieckmann P. Human performance and patient safety. In: R Miller, LI Eriksson, LA Fleisher, JP Wiener-Kronish, eds. Miller′s Anesthesia. Philadelphia: Elsevier Churchill Livingstone, 2009: 93– 150. Google Scholar 6 World Health Organisation. World Health Organisation Surgical Safety Checklist, 1st edn, http://www.who.int/patientsafety/safesurgery/tools_resources/SSSL_Checklist_finalJun08.pdf (accessed 14/09/2010). Google Scholar 7 Clinical Human Factors Group. The Case of Elaine Bromiley. http://www.chfg.org/wp-content/uploads/ElaineBromileyAnonymousReport.pdf (accessed 14/09/2010). Google Scholar Citing Literature Volume66, Issue3March 2011Pages 223-224 ReferencesRelatedInformation
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