survey of the current use of neuromuscular blocking drugs among the Middle Eastern anesthesiologists

This survey aimed to assess the extent of practice of the Middle Eastern anesthesiologists in the use of neuromuscular blocking agents [NMB] in 2012. We distributed an electronic survey among 577 members of the Triple-M Middle Eastern Yahoo anesthesia group, enquiring about their practice in the use of neuromuscular blocking agents. Questions concerned the routine "first choice" use of NMB, choice for tracheal intubation, the use of neuromuscular monitoring [NMT], type of NMB used in difficult airway, frequency of using suxamethonium, cisatracurium, rocuronium and sugammadex, observed side effects of rocuronium, residual curarization, and the reversal of residual curarization of rocuronium. A total of 71 responses from 22 Middle Eastern institutions were collected. Most of the Middle Eastern anesthesiologists were using cisatracurium and rocuronium frequently for tracheal intubation [39% and 35%, respectively]. From the respondents, 2/3 were using suxamethonium for tracheal intubation in difficult airway, 1/3 were using rocuronium routinely and 17% have observed hypersensitivity reactions to rocuronium, 54% reported residual curarization from rocuronium, 78% were routinely using neostigmine to reverse the rocuronium, 21% used sugammadex occasionally, and 35% were using NMT routinely during the use of NMB. We believe that more could be done to increase the awareness of the Middle Eastern anesthesiologists about the high incidence of PROC [>20%] and the need for routine monitoring of neuromuscular function. This could be accomplished with by developing formal training programs and providing official guidelines

Safety of intraneural injection of local anesthetic

There is conflicting information in the literature regarding nerve damage following regional anesthesia. Intraneural injection of local anesthetic was described as a safe practice in regional anesthesia. This review focuses on the histopathological and functional assessment of peripheral nerve function following intraneural injection of local anesthetics

Anesthesia for thoracic surgery: a survey of middle eastern practice

The main objective of this survey is to describe the current practice of thoracic anesthesia in the Middle Eastern [ME] region. A prospective online survey. An invitation to participate was e-mailed to all members of the ME thoracic- anaesthesia group. A total of 58 members participated in the survey from 19 institutions in the Middle East. Questions concerned ventilation strategies during one-lung ventilation [OLV], anesthesia regimen, mode of postoperative analgesia, use of lung isolation techniques, and use of i.v. fluids. Volume-controlled ventilation was favored over pressure-controlled ventilation [62% vs 38% of respondents, P < 0.05]; 43% report the routine use of positive end-expiratory pressure. One hundred percent of respondents report using double-lumen tube [DLT] as a first choice airway to establish OLV. Nearly a third of respondents, 31.1%, report never using bronchial blocker [BB] in their thoracic anesthesia practice. Failure to pass a DLT and difficult airway are the most commonly cited indications for BB use. Regarding postoperative analgesia, the majority 61.8% favor thoracic epidural analgesia over other techniques [P < 0.05]. Our survey provides a contemporary snapshot of the ME thoracic anesthetic practice