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

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. MATERIAL AND METHODS: The cross-sectional survey was applied at the Updated Course of the Colegio Mexicano de Anestesiología performed last year. Of 989, 282 (28.5%) surveys were returned. RESULTS: Most anesthesiologists were working at both public and private hospitals, performed anesthetic procedures for hospitalized and ambulatory patients, and anesthetized children as well as adults. Respondents did not consider mechanomyography as the gold standard method for neuromuscular monitoring. The T(25) was not recognized as a pharmacodynamic parameter that represents the clinical duration of the neuromuscular block. Most answered that vecuronium induces less histamine release than rocuronium, had never used any neuromuscular monitor, did not know the cost of vecuronium and rocuronium, and preferred rocuronium in multiple-sampling vials and vecuronium in either a vial for single or multiple sampling. Rocuronium was preferred for emergency surgery in patients with full stomach only. Almost all of anesthesiologists that conserve the unused drug did it without refrigeration and more than 30% conserve the unused drug in one syringe for further use. CONCLUSION: Vecuronium was preferred for most clinical situations, and the decision for this choice was not based on costs. Storage of unused drugs without refrigeration in a single syringe for purpose of future use in several patients represented a dangerous common practice

Attitudes of Mexican anesthesiologists to indicate preoperative fasting periods: A cross-sectional survey

BACKGROUND: In Mexico, guidelines for fasting periods, or any audits on this topic are unavailable, and therefore the attitudes of anesthesiologists for recommending preoperative fasting periods are unknown. MATERIAL AND METHODS: The study was a cross-sectional survey of anesthesiologists subscribed to the Annual Updated Course, organized by the Sociedad Mexicana de Anestesiologia in 2000. The response rate was 31.4%. RESULTS: Most respondents were general anesthesiologists, with 5 or more years experience in a clinical post, were working in both public and private hospitals, and were performing anesthetic procedures on both pediatric and adult patients and in both ambulatory and hospitalized patients. Approximately 23% of the respondents considered natural fruit juices to be clear liquids. For a pediatric patient ingesting breast milk 1 h before undergoing a surgical procedure, 45% thought that surgery should be delayed for 3h, followed by those delaying the surgical procedure for 6 to 8 h. Our results show that more than 50% of the anesthesiologists had better defined attitudes for fasting milk and clear liquids in patients of 6 month or under than for older children and adults. However, due to the poor definition or pre-operative fasting, using clear liquids, in all other patient groups, several patients are allowed to go without oral clear liquids administration for prolonged periods. CONCLUSION: Preoperative fasting periods recommended by Mexican anesthesiologists differ from international guidelines

Effect of mivacurium 200 and 250 μg/kg in infants during isoflurane anesthesia: a randomized controlled trial [ISRCTN07742712]

BACKGROUND: Infants usually respond differently to a neuromuscular relaxant compared to children or adults. Isoflurane is commonly used as an anesthetic gas in infants. In an RCT design, we investigated whether a dose of mivacurium 250 μg/kg results in faster onset of action than 200 μg/kg in infants under isoflurane anesthesia. Spontaneous recovery times and cardiovascular response were also evaluated. METHODS: Twenty-four low surgical risk children, aged 6–24 months, undergoing an elective surgery and requiring tracheal intubation were selected. After anesthetic induction, patients randomly received an iv bolus dose of mivacurium 200 or 250 μg/kg. After maximal relaxation, the patient was intubated. Isoflurane was administered to maintain anesthetic level during the surgical procedure. Neuromuscular function was monitored by accelerometry (TOF-Guard) at the adductor pollicies. The first twitch (T) of the TOF and the T4/T1 were measured. The time-course of heart rate and systolic and diastolic blood pressure were analysed by transforming them into their respective areas under the curve. RESULTS: Mivacurium 250 μg/kg produced a maximal T block faster than 200 μg/kg, i.e. 2.4 ± 1.1 vs. 3.5 ± 1.4 min (p < 0.05). Spontaneous recovery times were similar in both groups. Heart rate was similar between doses while systolic and diastolic blood pressures were lower with the higher dose (p < 0.05). Flushing was observed in two cases, one in each group. CONCLUSIONS: The maximal effect of mivacurium 250 μg/kg, in infants under isoflurane anesthesia, was present one minute faster than 200 μg/kg. However, it produced a significant cardiovascular response

Recomendaciones para la buena práctica de la medicina en anestesiología

At present, the Anesthesiology is recognized as a medical discipline and the activities of the anesthesiologist are wide, since it interferes in all the processes that happen during the anesthetic - surgical act. The most common reason of damages or serious complications they are associated with faults in the suitable ventilation of the patient. The aim of the present work is to generate specific and general recommendations directed to specialists of Anesthesiology, from the analysis of the complaints received in the CONAMED. There were analyzed all the complaints received for the specialty of anesthesiology from June, 1996 to May, 2001. Sociodemographic variables were included, information about institution of health and motive of complaint among others. There was included information of the Medical Integral Valuation, to obtain the type of used anesthesia. For the analysis descriptive statistics was used, for this intention it was used SPSS 10.1. Results: there was analyzed a whole of 97 complaints, 74.2 % of the complaints corresponded to the female sex, average of age 34.3 years, the major proportion of the complaints were to institutions of Social Security (67.0%). The proportion of malpractice for type of institution was of 75 % in the private roads, 57.4 % in Social Security and 52.6% in the Public Services. Problems identified with major frequency in the complaints with malpractice were in order: dural puncture, encephalopathy ischemic and cerebral irreversible damage and injury of nervous roots. Five deaths related with anesthesia were identified. The results obtained in the present work as for the problems in the practice of anesthesiology are very similar to the reported ones in the literature and a proportion of cases they can be prevenibles across a better training and supervision of the procedures that are realized.En la actualidad, la Anestesiología se reconoce como una disciplina médica y las actividades del anestesiólogo son amplias, ya que se involucra en todos los procesos que ocurren durante el acto anestésico-quirúrgico. La causa más común de daños o complicaciones serias están asociadas con fallas en la ventilación adecuada del paciente. El objetivo del presente trabajo es emitir recomendaciones generales y específicas, dirigidas a los especialistas de Anestesiología, a partir del análisis de las quejas recibidas en la CONAMED. Se analizaron todas las quejas recibidas en la CONAMED para la especialidad de anestesiología de junio de 1996 a mayo de 2001. Se incluyeron variables sociodemográficas, de la institución de salud y motivo de queja entre otras. Se incluyó información de la Valoración Médica Integral, para obtener el tipo de anestesia utilizada. Para el análisis se empleó estadística descriptiva, para este propósito se utilizó el paquete estadístico SPSS 10.1. Resultados: se analizaron un total de 97 quejas, 74.2% de las quejas correspondieron al sexo femenino, promedio de edad pacientes 34.3 años, la mayor proporción de las quejas correspondió a instituciones de Seguridad Social (67.0%). La proporción de mala práctica por tipo de institución fue de 75% en las privadas, 57.4% en seguridad social y 52.6% en servicios públicos. Los problemas identificados con mayor frecuencia en las quejas con mala práctica fueron: perforación de duramadre, seguida por la encefalopatía anoxoisquémica, el tercer lugar para daño cerebral irreversible y lesión de raíces nerviosas. Se identificaron 5 defunciones relacionadas con la anestesia. Los resultados obtenidos en el presente trabajo en cuanto a los problemas en la práctica de la anestesiología son muy semejantes a los reportados en la literatura y una proporción de casos pueden ser prevenibles a través de una mejor capacitación y supervisión de los procedimientos anestésicos que se realizan