Rapid sequence induction : an international survey

BACKGROUND Rapid sequence induction (RSI) is a standard procedure, which should be implemented in all patients with a risk of aspiration/regurgitation during anaesthesia induction. OBJECTIVE The primary aim was to evaluate clinical practice in RSI, both in adult and paediatric populations. DESIGN Online survey. SETTINGS A total of 56 countries. PARTICIPANTS Members of the European Society of Anaesthesiology. MAIN OUTCOME MEASURES The aim was to identify and describe the actual clinical practice of RSI related to general anaesthesia. RESULTS From the 1921 respondents, 76.5% (n=1469) were qualified anaesthesiologists. When anaesthetising adults, the majority (61.7%, n=1081) of the respondents preoxygenated patients with 100% O-2 for 3 min and 65.9% (n=1155) administered opioids during RSI. The Sellick manoeuvre was used by 38.5% (n=675) and was not used by 37.4%(n=656) of respondents. First-linemedications for a haemodynamically stable adult patient were propofol (90.6%, n=1571) and suxamethonium (56.0%, n=932). Manual ventilation (inspiratory pressure<12cmH(2)O) was used in 35.5% (n=622) of respondents. In the majority of paediatric patients, 3 min of preoxygenation (56.6%, n=817) and opioids (54.9%, n=797) were administered. The Sellick manoeuvre and manual ventilation (inspiratory pressure <12cmH(2)O) in children were used by 23.5% (n=340) and 35.9% (n=517) of respondents, respectively. First-line induction drugs for a haemodynamically stable child were propofol (82.8%, n=1153) and rocuronium (54.7%, n=741). CONCLUSION We found significant heterogeneity in the daily clinical practice of RSI. For patient safety, our findings emphasise the need for international RSI guidelines

Relations of COVID-19 and the Risk Management Framework

The routine approach used in risk management is based on the scheme that within the prevention period an organisation or a state prepares for the expected risks and once the risks occur, resources and internal procedures are implemented to mitigate their negative consequences. The objective of the paper is to analyse risk management and its constraints, its application in COVID-19 period and based on it provide mitigating strategies for specific problems/risks related to COVID-19. The research methods related to the topics are: (a) study of books, newspapers and other internet resources and (b) interviews with COVID-19 managers at district and regional level in the north of Slovakia. The proposals for mitigation strategies are based on the basic assumption relevant for COVID-19 that there are risks with unknown probability and unknown consequences. Therefore, the mitigation strategies are adapted to the current situation, which includes lack of data and know-how, lack of experience, political and economic unrest and social problems. The impact of constraints is based on an ad-hoc or unplanned and clearly structured approach. Problems and risks are identified and mitigation strategies are proposed. The proposed measures (quantitative/qualitative) should be evaluated and via benchmarking the development and efficiency of applied measures monitored and assessed. The output of identified risk-known and –unknown creates a framework for implementation

Fire Losses in the Slovak Republic - Their Classification and Quantification

The paper deals with approaches to fire loss classification and quantification. Direct and indirect loss, total loss per fire and the relation of direct and indirect loss to the gross domestic product (GDP) are calculated. Furthermore, the Statgraphics Centurion XV package is used to express: total loss prediction for selected probabilities and probabilities for selected total fire loss values. The results are discussed and conclusions drawn in form of recommendations for the Fire & Rescue Services management in the Slovak Republic

Žilina Self-Governing Region – Future Development Risks of Higher Territorial Units in Slovak Republic

Based on a budget analysis of Žilina Self-governing Region, the article points the future risk of development higher territorial units in the Slovak Republic. Authors also notes, that the financial possibilities of higher territorial units in solving the impacts of economic crisis. They're points out that the lack of financial resources for reduction of the economic crisis impacts is determined by various external and internal factors

Economic Security - A Principal Component of Multilevel Security Concept in Global Economy

This paper is focused on the problem of the economic security as the principal component of a multilevel security concept in the present global economy. The authors characterize various theoretical and practical notions of security as the complex phenomenon. The economic security as an integral component of the mentioned security concept is also characterized. The further text is concentrated on the global aspects of economic security, which are depicted in the examples in economies of China, the U.S.A. and the EU

Intraoperative transfusion practices in Europe

© 2016 The Author. Published by Oxford University Press on behalf of the British Journal of Anaesthesia.Background: Transfusion of allogeneic blood influences outcome after surgery. Despite widespread availability of transfusion guidelines, transfusion practices might vary among physicians, departments, hospitals and countries. Our aim was to determine the amount of packed red blood cells (pRBC) and blood products transfused intraoperatively, and to describe factors determining transfusion throughout Europe. Methods: We did a prospective observational cohort study enrolling 5803 patients in 126 European centres that received at least one pRBC unit intraoperatively, during a continuous three month period in 2013. Results: The overall intraoperative transfusion rate was 1.8%; 59% of transfusions were at least partially initiated as a result of a physiological transfusion trigger- mostly because of hypotension (55.4%) and/or tachycardia (30.7%). Haemoglobin (Hb)- based transfusion trigger alone initiated only 8.5% of transfusions. The Hb concentration [mean (sd)] just before transfusion was 8.1 (1.7) g dl-1 and increased to 9.8 (1.8) g dl-1 after transfusion. The mean number of intraoperatively transfused pRBC units was 2.5 (2.7) units (median 2). Conclusions: Although European Society of Anaesthesiology transfusion guidelines are moderately implemented in Europe with respect to Hb threshold for transfusion (7-9 g dl-1), there is still an urgent need for further educational efforts that focus on the number of pRBC units to be transfused at this threshold