Drugs Used for Reversal

1
Drugs Used for Reversal

• Santhosh
• Steve Cray
• Birmingham Childrens Hospital 2006

2
Concerns

• Multiple recipes
• Adrenaline/Atropine substitution
• Potential for confusion among trainees (and
  consultants if the trainee draws up reversal)
• Cost

3
Survey questions

• Preparation of reversal
• How many ampoules of Neostigmine used?
• Atropine or Glycopyrronium
• How many ampoules of Atropine or Glyco?
• What volume diluted to?
• Volume/dose given?
• Should we stock premixed Glyco/Neostigmine?
• Are you confused by various preparations and
  doses of reversal agents used in BCH?

4
Results

• Completed forms
• Consultants 16
• SpRs 10
• Antimuscarinic agent
• Atropine 22
• Glycopyrronium 5

5
Results

• Method of administration
• Neat 9
• Georges mixture 14
• Other dilution 5
• Multiple methods 3
• Odd doses 5

6
Results

• Confused?
• Yes 2
• No 6
• Used to be 1
• Didnt understand the question 1

7
Results

• Should we stock premixed ampoules of
  Glycopyrronium and Neostigmine?
• Yes 18
• No 3
• Undecided 4

8
Conclusions

• There are multiple different methods used at BCH
  for giving reversal agents
• Most currently use Atropine and Neostigmine
• There is general support for using premixed
  Glycopyrronium and Neostigmine
• There is little literature comparing reversal
  agents in children.

9
Costs

• Premixed Glyco/Neostigmine 1.01
• Atropine 0.50
• Neostigmine 0.58
• Glycopyrronium 1.01
• Edrophonium 4.76

10
Change of practice

• We all do the same
• 0.02 ml/kg of Glyco/Neostig
• Or dilute to 10ml and give 0.2 ml/kg