Residual Neuromuscular Blockade in the Critical Care Setting

2018 ◽  
Vol 29 (1) ◽  
pp. 15-24 ◽  
Author(s):  
Nicole Stawicki ◽  
Patty Gessner
Keyword(s):  
Neuromuscular Blockade ◽  
Acute Care ◽  
Care Setting ◽  
Recovery Process ◽  
Neuromuscular Blocking ◽  
Advanced Practice ◽  
Acute Care Setting ◽  
Residual Neuromuscular Blockade ◽  
Reversal Agents

Residual neuromuscular blockade is a widespread challenge for providers in the acute care setting that, if left unrecognized or untreated, places patients at higher risk for morbidity and mortality. The condition is estimated to occur in 26% to 88% of patients undergoing general anesthesia. The role of the advanced practice nurse in the acute care setting is to facilitate a safe recovery process by identifying early signs of deterioration and supporting the patient until full muscular strength has returned. This article discusses the prevalence of residual neuromuscular blockade and associated complications and patient risk factors. A review is included of the current uses for neuromuscular blockade, pathophysiology of the neuromuscular junction, pharmacologic characteristics of neuromuscular blocking agents (including drug-drug interactions), monitoring modalities, and effectiveness of reversal agents. Treatment recommendations pertinent to residual neuromuscular blockade are outlined.

The Role of Serum Lactate in the Acute Care Setting

2010 ◽  
Vol 25 (5) ◽  
pp. 286-300 ◽  
Author(s):  
Colleen B. Kjelland ◽  
Dennis Djogovic
Keyword(s):  
Acute Care ◽  
Care Setting ◽  
Serum Lactate ◽  
Acute Care Setting

Role of Aboriginal Health Workers and Liaison Officers in quality care in the Australian acute care setting: a systematic review

2020 ◽  
Vol 44 (3) ◽  
pp. 427 ◽  
Author(s):  
Tamara Mackean ◽  
Elizabeth Withall ◽  
Judith Dwyer ◽  
Annabelle Wilson
Keyword(s):  
Acute Care ◽  
Continuity Of Care ◽  
Care Setting ◽  
Health Workers ◽  
Quality Care ◽  
Medical Advice ◽  
Acute Care Setting ◽  
Against Medical Advice ◽  
Discharge Against Medical Advice

ObjectiveThe aim of this study was to identify the contribution of Aboriginal Health Workers and Liaison Officers (AHWLOs) to quality of care in the acute health care setting in Australia. MethodsA systematic review of peer-reviewed literature focused on the role of AHWLOs and quality processed and quality outcomes. Authors undertook study selection based on inclusion criteria and performed quality assessment using critical appraisal tools from the Joanna Briggs Institute. ResultsThe search revealed limited literature that met the inclusion criteria, namely four quantitative studies and one mixed-methods study. The settings of the included studies were mental health and cardiac care units within various hospitals. The studies indicated that AHWLOs may have a positive effect on communication between healthcare professionals and patients, rates of discharge against medical advice and continuity of care. Methodological constraints among the included studies made it difficult to establish specific contributions of AHWLOs to quality care markers across acute care units. ConclusionsThe role of AHWLOs in providing quality care in the acute care setting has received minimal research. The limited existing research highlights the importance of the AHWLO role. For example, AHWLOs may influence patient communication, discharge against medical advice and continuity of care within mental health and cardiac care units. Further, because of methodological constraints among the limited studies, research into the role of AHWLOs in these and other acute care settings is needed to assess effects on a range of specific clinical quality markers. What is known about the topic?Aboriginal and Torres Strait Islander people experience unacceptable health inequities. AHWLOs are a unique workforce introduced to increase access to culturally safe care and, ultimately, help to address these inequities. What does this paper add?This review explores the current evidence for the contribution of AHWLOs to quality care in the acute care setting. The findings suggest that these professionals may improve communication between patients and medical staff, improve continuity of care and reduce patient discharge against medical advice. However, these findings highlight that the use of quality care markers across acute care settings is needed to generate tangible evidence to help establish the legitimacy of these health professionals. What are the implications for practitioners?AHWLOs have a place in the acute care team. Although further research is required to expand the preliminary evidence base of their effect on quality acute care, this workforce should be supported at the individual, organisational and policy levels to enhance the health and well-being of one the most vulnerable communities in Australia.

The Use of Advanced Practice Nurses in the Acute Care Setting

Nurse Leader ◽  
2013 ◽  
Vol 11 (1) ◽  
pp. 40-45 ◽  
Author(s):  
Sylvain Trepanier ◽  
Patricia Duran ◽  
Linda Lawson
Keyword(s):  
Acute Care ◽  
Care Setting ◽  
Advanced Practice Nurses ◽  
Advanced Practice ◽  
Acute Care Setting ◽  
Practice Nurses

Neuromuscular Blockers and Reversal Agents

2019 ◽  
Author(s):  
Kristen Flight ◽  
Jennifer J Yang ◽  
Lindsay M Urben ◽  
Michael J Schontz
Keyword(s):  
Neuromuscular Blockade ◽  
Neuromuscular Transmission ◽  
Muscle Relaxation ◽  
Neuromuscular Blocking ◽  
Neuromuscular Monitoring ◽  
Clinical Effects ◽  
Duration Of Action ◽  
Residual Neuromuscular Blockade ◽  
Neuromuscular Blocking Drugs ◽  
Reversal Agents

Neuromuscular blocking drugs, which include depolarizing and nondepolarizing drugs, are used to facilitate intubation and provide skeletal muscle relaxation during surgery and in the intensive care unit. The agents differ in their mechanism, duration of action, side-effect profile, and metabolism. Succinylcholine is the only depolarizing agent in clinic use and is typically used for emergent control of the airway, rapid sequence intubations, and short surgical procedures. The risk of hyperkalemia in certain clinical conditions and risk of malignant hyperthermia in susceptible individuals limit the use of succinylcholine in specific patient populations. Nondepolarizing agents vary in their duration of action, but all provide muscle relaxation for a longer duration than succinylcholine. Clinical effects of neuromuscular blocking drugs can be assessed with neuromuscular monitoring, although there is significant variability among providers in the regular use of neuromuscular monitoring. Reversal agents are used to restore neuromuscular transmission, as residual neuromuscular blockade after extubation has been associated with multiple adverse events, including hypoxemia, atelectasis, and aspiration. Sugammadex is an encapsulating agent capable of immediately reversing the effects of rocuronium-induced neuromuscular blockade that will likely impact the way many providers administer rocuronium and may decrease the future use of succinylcholine. This review contains 4 figures, 6 tables, and 41 references. Keywords: hyperkalemia, neuromuscular monitoring, neuromuscular transmission, nondepolarizing neuromuscular blocking agents, residual neuromuscular blockade, reversal agents, succinylcholine sugammadex, sugammadex

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