Why the study?
Does the preparation and administration of sugammadex occur fast enough to save a patient in a simulated 'cannot intubate, cannot ventilate' situation?
Does the preparation and administration of sugammadex occur fast enough to save a patient in a simulated 'cannot intubate, cannot ventilate' situation?
In a simulated 'cannot intubate, cannot ventilate' scenario, the preparation and administration of sugammadex took an average of 6.7 minutes with frequent dosing errors, suggesting it may not be fast enough to prevent harm.
Delays and dosing errors in simulated CICV may preclude timely reversal; hypothesis-generating for protocol optimization and real-world validation.
Recent studies have shown that the use of high dose rocuronium followed by sugammadex provides a faster time to recovery from neuromuscular blockade following rapid sequence induction than suxamethonium. In a manikin-based 'cannot intubate, cannot ventilate' simulation, we studied the total time taken for anaesthetic teams to prepare and administer sugammadex from the time of their initial decision to use the drug. The mean (SD) total time to administration of sugammadex was 6.7 (1.5) min, following which a further 2.2 min (giving a total 8.9 min) should be allowed to achieve a train-of-four ratio of 0.9. Four (22%) teams gave the correct dose, 10 (56%) teams gave a dose that was lower than recommended, four (22%) teams gave a dose that was higher than recommended, six (33%) teams administered sugammadex in a single dose, and 12 (67%) teams gave multiple doses. Our simulation highlights that sugammadex might not have saved this patient in a 'cannot intubate, cannot ventilate' situation, and that difficulties and delays were encountered when identifying, preparing and administering the correct drug dose.
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Bisschops et al. (2010) studied this question.
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