Phase II and III trials recently demonstrated that sugammadex is not associated with an increased risk of postoperative hemorrhage or hypersensitivity reaction. A pooled analysis of more than 1850 patients showed that there were less drug-related adverse events in patients treated with sugammadex versus neostigmine/glycopyrrolate.  The study also found that sugammadex eliminated incidences of residual paralysis in PACU and decreased time between reversal and of the patient being OR discharge ready. http://tinyurl.com/pawszh8

Do your patients suffer from adverse outcomes related to residual NMB in the PACU? Surprising results from the RECITE study showed that 65% of patients have a TOF ratio below 0.9 at extubation. Dr Hoeft concluded, “The majority of patients are extubated too early.” http://tinyurl.com/lnj53y2

RBC transfusions may increase risk of infection: A recent study published in JAMA demonstrates that risk of infection is 17% with liberal RBC transfusion versus 12% with restrictive transfusion strategy (Hb <7). Notably, in orthopedic surgery, restrictive transfusion strategy reduced the risk for infection by 30%. http://tinyurl.com/ljrs8xr

Should all patients in the PACU have ETCO₂ monitoring? APSF President, Dr Robert K. Stoelting, noted, “Continuous electronic monitoring of oxygenation and/or ventilation may allow for more rapid diagnosis and prevention of drug-induced, postoperative respiratory depression.” EtCO₂ monitoring can help practitioners recognize opioid-induced respiratory depression before patient harm occurs. http://tinyurl.com/nx7r87q

Can anesthesia personnel safely utilize the beach chair position in the OR? Research shows that the beach chair (barbershop) position decreases cerebral perfusion pressure by 15% and BP by 28% to 42%. Anesthetists should remember that BP is lower in the brain than the arm in the sitting position, and that lack of brain profusion can place patients at risk for ischemic brain injury. http://tinyurl.com/lrcotls

POISE-2 trial data disappoints as no reduction in perioperative MI or mortality was found when aspirin or clonidine was administered perioperatively. In addition, major postsurgical bleeding risk was increased in the aspirin group. Since 8% of adults over 45 years old undergoing noncardiac surgery experience perioperative MIs, anesthetists must continue to look for effective pharmacological prevention measures. http://tinyurl.com/nv6dwpg

Hypothermia may be more common than anesthetists might predict, and it can contribute to prolonged hospital stays and increased transfusion rates. A recent study demonstrated that approximately 10% of patients undergoing noncardiac surgery had core temperatures of 35°C (95°F) at the end of surgery. Study authors recommend prewarming patients or developing more effective intraoperative warming systems. http://tinyurl.com/p5lg7tb

Do safety checklists reduce complications following surgery? According to a meta-analysis of 7 cohort studies involving 37 339 patients, the use of such checklists reduced complications, wound infections, and blood loss, but had no impact on mortality, pneumonia, or an unplanned return to the operating room. http://tinyurl.com/kfq95ep

Anesthetic neurotoxicity may significantly impact cognitive performance at both extremes of age. While preclinical studies point to harm, definitive clinical data remain elusive. http://tinyurl.com/nqa2x5g

Postoperative apnea following adenotonsillectomy in children with obstructive sleep apnea is more common than previously thought and can result in death or neurologic injury. This is a preventable event, and obese children with comorbidities are at a higher risk for this poor outcome. Risk assessment is essential in identifying these patients who should not be managed on an outpatient basis following day surgery. http://tinyurl.com/pfg2rys

The Wake-Up Safe initiative is a multi-institutional registry that tracks serious adverse events in pediatric anesthesia patients. As of March 2013, there were 19 member institutions, 736 365 anesthetics, and 734 serious adverse events, which were recorded by the second year of membership. A resulting rate of 1.4 serious adverse events per 1000 anesthetics was calculated. http://tinyurl.com/omqlcy8

Myocardial injury following noncardiac surgery (MINS) is common and associated with substantial mortality. An international multicenter study aimed to determine the diagnostic criteria, characteristics, predictors, and 30-day outcomes of patients who experienced MINS. Researchers prospectively followed 15 065 patients 45 years or older; 1200 patients (8%) experienced MINS with 260 (2%) deaths at 30 days. http://tinyurl.com/krv4bwl

Does the location of neuromuscular monitoring matter? A recent study suggests that patients whose NM function is monitored on the face are 3.5 times more likely to experience residual paralysis than those monitored at the wrist. In discussing the study’s importance, study investigator, Stephan Thilen, MD, MS, noted that anesthesia providers tend to “…underestimate the importance of residual paralysis as a risk factor for immediate postoperative complications in the recovery room.” http://tinyurl.com/mmzwd9u Click here for complete study results.

Do intermediate-acting NMBs increase the risk of adverse postoperative respiratory events? A recent study demonstrated that NMB with vecuronium, rocuronium, and cisatracurium was associated with increased risks for hypoxic events after extubation and increased risk for reintubation. In addition, only half of the clinicians in this study used neuromuscular monitoring and less than two-thirds used reversal agents. http://tinyurl.com/nmp7veo