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Background: Residual neuromuscular block has been associated with postoperative pulmonary complications. We hypothesised that sugammadex reduces postoperative pulmonary complications in patients aged ≥70 yr having surgery ≥3 h, compared with neostigmine., Methods: Patients were enrolled in an open-label, assessor-blinded, randomised, controlled trial. At surgical closure, subjects were equally randomised to receive sugammadex 2 mg kg -1 or neostigmine 0.07 mg kg -1 (maximum 5 mg) for rocuronium reversal. The primary endpoint was incidence of postoperative pulmonary complications. Secondary endpoints included residual paralysis (train-of-four ratio <0.9 in the PACU) and Phase 1 recovery (time to attain pain control and stable respiratory, haemodynamic, and neurological status). The analysis was by intention-to-treat., Results: Of the 200 subjects randomised, 98 received sugammadex and 99 received neostigmine. There was no significant difference in the primary endpoint of postoperative pulmonary complications despite a signal towards reduced incidence for sugammadex (33% vs 40%; odds ratio [OR]=0.74; 95% confidence interval [CI]=[0.40, 1.37]; P=0.30) compared with neostigmine. Sugammadex decreased residual neuromuscular block (10% vs 49%; OR=0.11, 95% CI=[0.04, 0.25]; P<0.001). Phase 1 recovery time was comparable between sugammadex (97.3 min [standard deviation, sd=54.3]) and neostigmine (110.0 min [sd=62.0]), difference -12.7 min (95% CI, [-29.2, 3.9], P=0.13). In an exploratory analysis, there were fewer 30 day hospital readmissions in the sugammadex group compared with the neostigmine group (5% vs 15%; OR=0.30, 95% CI=[0.08, 0.91]; P=0.03)., Conclusions: In older adults undergoing prolonged surgery, sugammadex was associated with a 40% reduction in residual neuromuscular block, a 10% reduction in 30 day hospital readmission rate, but no difference in the occurrence of postoperative pulmonary complications. Based on this exploratory study, larger studies should determine whether sugammadex may reduce postoperative pulmonary complications and 30 day hospital readmissions., Clinical Trial Registration: NCT02861131., (Copyright © 2020 British Journal of Anaesthesia. Published by Elsevier Ltd. All rights reserved.)

Study Objective: Ehlers-Danlos syndrome (EDS) is an inherited disease characterized by defects in various collagens or their post translational modification, with an incidence estimated at 1 in 5000. Performance of peripheral nerve block in patients with EDS is controversial, due to easy bruising and hematoma formation after injections as well as reports of reduced block efficacy. The objective of this study was to review the charts of EDS patients who had received peripheral nerve block for any evidence of complications or reduced efficacy., Design: Case series, chart review., Setting: Academic medical center., Patients: Patients with a confirmed or probable diagnosis of EDS who had received a peripheral nerve block in the last 3 years were identified by searching our institutions electronic medical record system., Interventions: The patients were classified by their subtype of EDS. Patients with no diagnosed subtype were given a probable subtype based on a chart review of the patient's symptoms., Measurements: Patient charts were reviewed for any evidence of complications or reduced block efficacy., Main Results: A total of 21 regional anesthetics, on 16 unique patients were identified, 10 of which had a EDS subtype diagnosis. The majority of these patients had a diagnosis of hypermobility-type EDS. No block complications were noted in any patients. Two block failures requiring repeat block were noted, and four patients reported uncontrolled pain on postoperative day one despite successful placement of a peripheral nerve catheter. Additionally, blocks were performed without incident in patients with classical-type and vascular-type EDS although the number was so small that no conclusions can be drawn about relative safety of regional anesthesia in these groups., Conclusions: This series fails to show an increased risk of complications of peripheral nerve blockade in patients with hypermobility-type EDS., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Study Objective: To determine the effectiveness of a short educational video and simulation on improvement of ultrasound (US) image acquisition and interpretation skills., Design: Prospective, randomized study., Setting: University medical center., Subjects: 28 anesthesia residents and community anesthesiologists with varied ultrasound experience were randomized to teaching video with interactive simulation or sham video groups., Subjects: Participants were assessed preintervention and postintervention on their ability to identify the sciatic nerve and other anatomic structures on static US images, as well as their ability to locate the sciatic nerve with US on live models., Main Results: Pretest written test scores correlated with reported US block experience (Kendall tau rank r = 0.47) and with live US scanning scores (r = 0.64). The teaching video and simulation significantly improved scores on the written examination (P < 0.001); however, they did not significantly improve live US scanning skills., Conclusions: A short educational video with interactive simulation significantly improved knowledge of US anatomy, but failed to improve hands-on performance of US scanning to localize the nerve., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Study Objective: To evaluate complications associated with ambulatory continuous lumbar plexus blocks., Design: Retrospective review of all patients who received a continuous lumbar plexus block for analgesia following arthroscopic hip surgery from January 2004 to July 2009., Setting: Academic medical center., Measurements: Data from 213 patients who were discharged home with a continuous lumbar plexus block following hip arthroscopy were studied. Side effects and complications, including impaired ambulation, systemic local anesthetic toxicity, abnormal local anesthetic spread, and neurologic injury, were recorded., Main Results: Of the 281 patients who received a continuous lumbar plexus block following hip arthroscopy, 213 were discharged home with the continuous lumbar plexus block. Significant complications occurred in 3.8% of patients (8/213). Twenty of 213 patients (9.4%) reported prolonged sensory or motor deficits after the continuous lumbar plexus block was removed. Most of these deficits were minor and resolved spontaneously, but 4 patients (1.9%) experienced persistent neurologic symptoms. One patient had a fall, one patient was readmitted for possible bilateral spread from the continuous lumbar plexus block, and two patients experienced symptoms of local anesthetic systemic toxicity (LAST)., Conclusions: While complications associated with hip arthroscopy with ambulatory continuous lumbar plexus blocks do occur, significant complications are uncommon. Most complications are managed easily on an outpatient basis. However, nearly 1% of patients presented with symptoms concerning for LAST and were treated without any hemodynamic compromise., (Published by Elsevier Inc.)

Study Objective: To test the sterility of medication vial tops after removal of the dust cover, and to survey anesthesia providers for their perceptions surrounding medication vials and sterility., Design: Experimental design and survey instrument., Setting: Ambulatory and hospital care setting., Participants: Anesthesia providers in the United States., Measurements: A two-question survey was distributed to anesthesia providers in the U.S. An experimental model was conducted on a total of 42 medication vials. The access diaphragms of medication vials were sampled after routine handling, after exposure to aerosolized contamination with the dust cover on, and after submersion into a bacterial medium with the dust cover on., Main Results: 878 responses to Question 1 and 876 responses to Question 2 were received. Fifty-two percent of respondents declared that the access diaphragm was sterile in routine conditions, and 43% felt that (or were unsure if) the dust cover would prevent contamination when exposed to a contaminated environment. Two of the 12 vials sampled in the routine handling model had microbial contaminants on the access diaphragm. No growth was found on any of the 15 vials exposed to aerosolized E. coli. Seven of the 15 vials in the submersion model were contaminated., Conclusions: Anesthesia providers in the U.S. possess contradictory opinions of, and unclear knowledge about, the sterility of rubber stoppers used to access medications, and also the barrier capacity of a vial's dust cover. Standard anesthetic medication vial dust covers do not offer barrier protection against the growth of pathogens., (Copyright © 2013 Elsevier Inc. All rights reserved.)