SUCCINYLCHOLINE USE BY ANESTHESIOLOGISTS IN CROATIA – IS IT REALLY ABANDONED?
Autori:
Mladen Carev, Nenad Karanović, Ante Ujević, Goran Kardum, Vesna Čengić, Natasha Funck, Nataša Čulić, Goran Račić, Zoran Đogaš
Sažetak
Sažetak. Cilj studije bio je utvrditi prevalenciju uporabe sukcinil-kolina među hrvatskim anesteziolozima u elektivnoj i hitnoj kirurgiji odraslih, kao i u dječjoj kirurgiji, te istražiti možebitne razlike u uporabi ovisno o spolu, položaju, iskustvu i radnome mjestu liječnika. Proučavana su osobna mišljenja o lijeku, kao i doživljene nuspojave u kliničkoj praksi. Ukupno 125 anesteziologa (od 590 u RH) iz općih i županijskih bolnica anonimno je ispunilo posebno strukturirani upitnik o uporabi sukcinil-kolina (Dodatak 1). Razlike u uporabi lijeka s obzirom na spol, položaj, radno mjesto i radno iskustvo testirane su s pomoću 2-testa i Fisherova egzaktnog testa. P<0,05 smatrao se statistički značajnim. Velika većina (oko 70%) anesteziologa u Hrvatskoj još uvijek rabi sukcinil-kolin. Udio anesteziologa koji ga nikad ne rabe iznosi 20% za elektivnu kirurgiju odraslih, 6% za hitne zahvate kod odraslih i 31% u dječjoj kirurgiji. Nije bilo statistički značajne razlike u uporabi sukcinil-kolina s obzirom na položaj, radno mjesto i radno iskustvo, ali muški ga anesteziolozi rjeđe rabe u dječjoj anesteziji u usporedbi sa svojim kolegicama (2= 5,08; p=0,02). Čak 42% liječnika nije nikad imalo komplikaciju zbog uporabe lijeka. Najčešće navedene nuspojave bile su bradikardija (67%) i bol u mišićima (54%), a slijede produljena blokada (33%) i alergije (33%). Asistoliju kod bolesnika doživjelo je 10% ispitanika. U zaključku, sukcinil-kolin još uvijek ima široku primjenu među anesteziolozima u Hrvatskoj. Većina ispitanih liječnika svjesna je mogućih opasnih nuspojava tog lijeka, ali ga rabi u posebnim kliničkim situacijama. Stoga indikacije i kontraindikacije za njegovu uporabu zaslužuju posebne smjernice, zasnovane na dostupnim znanstvenim dokazima.
Summary
Summary. The aim was to establish the prevalence of succinylcholine use among Croatian anesthesiologists in adult elective and emergency surgery, as well as in pediatric surgery, regarding gender, position, working place, and working experience of physicians. The anesthesiologists were expected to express their personal opinions regarding the drug, as well as experienced side effects in their own clinical practice. A total of 125 anesthesiologists (out of 590 in Croatia) from both university and county hospitals in Croatia anonymously filled out the questionnaire regarding the use of succinylcholine (Appendix 1). The questionnaire was structured to assess the use of succinylcholine in adult elective and emergency surgery, and in pediatric anesthesia, to obtain the reasons for the preference or rejection of succinylcholine, and information about observed side effects. The differences in use regarding gender, position, working place, and working experience were tested using chi-squared test and Fisher’s exact test. p<0.05 was considered significant. Vast majority (approximately 70%) of anesthesiologists in Croatia still use succinylcholine. The percentages of anesthesiologists that never use succinylcholine in adult elective, adult emergency and pediatric surgery were 20%, 6%, and 31%, respectively. There were no significant differences in the use of succinylcholine regarding position, working place, and working experience, but male anesthesiologists used it less frequently in pediatric anesthesia compared with their female colleagues (2= 5.08; p=0.02). Forty-two per cent never experienced a complication from the drug use. The most frequently reported side effects were bradycardias (67%) and myalgias (54%), followed by prolonged blockade (33%), and allergy (33%). Asystole was reported by 10% of the respondents. In conclusion, succinylcholine is still widely used by anesthesiologists in Croatia. The majority of surveyed physicians were aware of its possible dangerous adverse effects, but still use it in certain situations. Therefore, indications and contraindications for its use deserve expert consensus guidelines based on the available scientific evidence.
