Drugs Used for ReversalDrugs Used for Reversal

SanthoshSanthosh

Steve CraySteve Cray

Birmingham Children’s Hospital Birmingham Children’s Hospital 20062006

ConcernsConcerns

Multiple “recipes”Multiple “recipes”

Adrenaline/Atropine substitutionAdrenaline/Atropine substitution

Potential for confusion among trainees (and Potential for confusion among trainees (and consultants if the trainee draws up reversal)consultants if the trainee draws up reversal)

CostCost

Survey questionsSurvey questions

Preparation of reversal:Preparation of reversal: How many ampoules of Neostigmine used?How many ampoules of Neostigmine used? Atropine or GlycopyrroniumAtropine or Glycopyrronium How many ampoules of Atropine or Glyco?How many ampoules of Atropine or Glyco? What volume diluted to?What volume diluted to? Volume/dose given?Volume/dose given? Should we stock premixed Glyco/Neostigmine?Should we stock premixed Glyco/Neostigmine?

Are you confused by various preparations and doses Are you confused by various preparations and doses of reversal agents used in BCH?of reversal agents used in BCH?

ResultsResults

Completed formsCompleted forms ConsultantsConsultants 1616 SpRsSpRs 1010

Antimuscarinic agentAntimuscarinic agent AtropineAtropine 2222 GlycopyrroniumGlycopyrronium55

ResultsResults

Method of administrationMethod of administration NeatNeat 99 George’s mixtureGeorge’s mixture 1414 Other dilutionOther dilution 55 Multiple methodsMultiple methods 33 Odd dosesOdd doses 55

ResultsResults

Confused?Confused? Yes:Yes: 22 No:No: 66 Used to be:Used to be: 11 Didn’t understand the question:Didn’t understand the question: 11

ResultsResults

Should we stock premixed ampoules of Should we stock premixed ampoules of Glycopyrronium and Neostigmine?Glycopyrronium and Neostigmine?

Yes:Yes: 1818 No:No: 33 Undecided:Undecided: 44

ConclusionsConclusions

There are multiple different methods used at BCH for There are multiple different methods used at BCH for giving reversal agentsgiving reversal agents

Most currently use Atropine and NeostigmineMost currently use Atropine and Neostigmine

There is general support for using premixed There is general support for using premixed Glycopyrronium and NeostigmineGlycopyrronium and Neostigmine

There is little literature comparing reversal agents in There is little literature comparing reversal agents in children.children.

CostsCosts

Premixed Glyco/Neostigmine = £1.01Premixed Glyco/Neostigmine = £1.01

Atropine = £0.50Atropine = £0.50

Neostigmine = £0.58Neostigmine = £0.58

Glycopyrronium = £1.01Glycopyrronium = £1.01

Edrophonium = £4.76Edrophonium = £4.76

Change of practiceChange of practice

We all do the sameWe all do the same

0.02 ml/kg of Glyco/Neostig0.02 ml/kg of Glyco/Neostig

Or dilute to 10ml and give 0.2 ml/kgOr dilute to 10ml and give 0.2 ml/kg