Succinylcholine use in adult anesthesia - A multinational questionnaire survey.

There are no definitive evidence based standards regarding use of succinylcholine (SCh) for anesthesia induction. However, there is a global trend toward eliminating SCh not only in elective, but also in emergency surgery in adults. The aim of the study was to survey the use of SCh in adult elective and emergency anesthesia practice in several European countries and the United States by questionnaire. One hundred and seventy anesthesiologists out of 201 possible, from six institutions in five countries (Croatia, Bosnia and Herzegovina, Hungary, United Kingdom, and the United States) anonymously completed the questionnaire about their use of SCh. The questionnaire was structured to assess the respondents': frequency of use of SCh in adult surgery (elective and emergency), reasons for use or rejection of SCh, positive and negative attributes of SCh, and observed side effects in their practice. Differences in use were tested using X2-test when appropriate. There was a significant difference in the use of SCh between countries for elective surgery with the lower use in UK and Hungary (chi2=45.8, p <0.001). One hundred and seventeen (69%) use it regularly. In emergency surgery 165 (97%) anesthesiologists use it without any significant difference among countries (chi2=2.13, p<0.711). The top indications for SCh use were anticipated difficult intubation/ventilation (74%), caesarean section (54%), and obesity and/or hiatus hernia (49%). The top reasons against SCh use were adequate substitutes (87%), fear of arrhythmias (45%), and anaphylaxis (19%). The most desirable reported drug features were: rapid onset (88%), short duration (64%), and effective relaxation (61%). Forty-six per cent of the surveyed anesthesiologists stated they had never experienced a complication with its use. The most frequently reported side effects were myalgias (47%), bradycardias (42%), and prolonged blockade (39%). Allergic reactions were reported by 13%, and asystole by 12% of physicians. From our survey it is possible to conclude that succinylcholine is still regularly used, at least by surveyed anesthesiologists in Europe and USA, in adult anesthesia practice, especially in elective surgery for which it may be least suited. This reflects the discrepancies between the international guidelines for the use of SCh and the clinical practice of many anesthesiologists in different countries. The regional differences in SCh usage may be considered through anesthesia cultures and practice variations depending on country.

[Local anesthesia in ophthalmologic surgery]. / Lokalna anestezija u ocnoj hirurgiji.

Operations of the anterior segment of the eye are dominant in ophthalmic surgery. It is a lesser known fact that these are the most common elective surgical procedures of all. There has been a dramatic change of anaesthetic practice for ophthalmic surgery over the last twelve years. LA is the anaesthetic of choice nowadays unless contraindicated. These changes were brought about due to the fact that anaesthetists initially became involved and then took over the performance of LA in ophthalmology. Peribulbar technique was introduced in 1986 as a safer alternative to retrobulbar anaesthesia. The needle tip is placed outside the muscle cone (in the peribulbar space). Adequate eyelid blockade and good hypotony of the eye is achieved. Perforation of the eyebulb is extremely rare complication. Sub-Tenon's anaesthesia is a new method of direct infiltration of local anaesthetic into sub-Tenon's space using a blunt cannula. Sub Tenon blocks avoid blind sharp needle penetration into space of the orbit. Although still a relatively new technique, sub-Tenon's anaesthesia is becoming increasingly popular. Day care intraocular surgery under local anaesthetic is the option of choice. Patients are admitted, operated on and discharged within few hours.