Patient and Provider Satisfaction With Telehealth Preanesthesia Examinations.

PURPOSE: Telehealth has become commonplace in many healthcare systems across the United States. Due to the COVID-19 pandemic, a large academic medical center in the southeast USA has increased the use of telehealth in the anesthesia department to complete preanesthetic assessments before the patient's surgery. This has allowed high-risk patient populations to limit potential exposure to COVID-19 and limit the financial burden of traveling from neighboring counties to complete their preanesthetic assessment in person. The purpose of this quality improvement project was to evaluate the effectiveness of a preanesthetic assessment via telehealth among patients undergoing anesthesia. DESIGN: A quality improvement project. METHODS: Two separate surveys assessing patient and provider satisfaction with telehealth preanesthesia assessments were developed. Patients undergoing anesthesia at the medical center completed a telehealth preanesthesia assessment and received a satisfaction survey via email post-procedure. Certified registered nurse anesthetists (CRNAs) who cared for patients that completed a telehealth preanesthesia assessment also received an emailed satisfaction survey. FINDINGS: Results demonstrate high satisfaction scores for both patients and providers. CONCLUSIONS: Current telehealth preanesthetic assessments prompt high satisfaction scores, supporting continued, and expanded use.

Prolonged neuromuscular paralysis following rapid-sequence intubation with succinylcholine.

OBJECTIVE: To report a case of severely prolonged succinylcholine-induced neuromuscular paralysis in a patient with previously undiagnosed butyrylcholinesterase deficiency. CASE SUMMARY: A 54-year-old female was admitted for surgical drainage of a groin abscess. She was given propofol 200 mg and succinylcholine 160 mg (1 mg/kg) intravenously to induce sedation and paralysis for endotracheal intubation. Thirty minutes after the 19-minute procedure, the patient showed no evidence of spontaneous recovery of respiration. She was transferred to the intensive care unit and 11 hours later was successfully weaned from the ventilator and extubated. A butyrylcholinesterase level of 552 IU/L (reference range 2673-6592) confirmed butyrylcholinesterase deficiency. Six months later, in compliance with institutional review board/human subjects research requirements, the patient returned for a dibucaine inhibition test and second butyrylcholinesterase assay; the butyrylcholinesterase level in the second assay was 789 IU/L. The dibucaine inhibition test result was 61.1% (reference range 81.6-88.3), suggesting that the adverse drug effect had a pharmacogenetic basis. Use of the Naranjo probability scale indicated a probable relationship between the prolonged neuromuscular paralysis and succinylcholine therapy in this patient. DISCUSSION: Succinylcholine remains the drug of choice to facilitate rapid-sequence endotracheal intubation during induction of anesthesia and in patients undergoing emergency procedures who are at risk for gastroesophageal regurgitation. Its short duration of action is due to rapid hydrolysis by the endogenous enzyme butyrylcholinesterase. Rarely, patients with butyrylcholinesterase deficiency may show marked sensitivity to succinylcholine, manifested clinically by severely prolonged neuromuscular paralysis and apnea. CONCLUSIONS: Butyrylcholinesterase deficiency may go undiagnosed for decades until succinylcholine is used in a surgical procedure. When it does occur, a butyrylcholinesterase level should be obtained and a dibucaine inhibition test should be conducted to test for unrecognized hereditary butyrylcholinesterase deficiency. If a pharmacogenetic basis is confirmed, the patient should receive information about the condition, implications, inheritance, and need for family testing.