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Wednesday, November 2, 2016

Succinylcholine aka Suxamethonium


 ⚗️Two molecules of acetyl choline joined together by the acetyl group forms Succinylcholine 

⚗️ It can be presented as chloride, bromide or iodide salt

⚗️ When presented as the chloride salt, it's a solution with concentration 50 mg/ mL

⚗️ When presented as bromide or iodide salts, they are powders, with more stability, shell life and suited for warm climates; but has to be reconstituted before use

⚗️ pH of the solution is around 4

⚗️ So they are destroyed by mixing it with alkaline solutions (e.g. Thiopentone )

Reference: Kestin I. Suxamethonium. Update in Anaesthesia 1992; 1: article 7.  Peck T, Hill S, Williams M. Pharmacology for Anaesthesia and Intensive Care, 3rd edn. Cambridge: Cambridge University Press, 2008; pp. 179–84 .

Monday, October 31, 2016

Visual Analogue Scale & Statistical Concerns


๐Ÿ”ธA frequently used tool in anaesthesia research is the 100 mm visual analogue scale (VAS). 

๐Ÿ”ธThis is most commonly used to measure postoperative pain, but can also be used to measure a diverse range of (mostly) subjective experiences such as preoperative anxiety, postoperative nausea, and patient satisfaction after ICU discharge. 

๐Ÿ”ธBecause there are infinite possible values that can occur throughout the range 0-100 mm, describing a continuum of pain intensity, most researchers treat the resulting data as continuous. 

๐Ÿ”ธIf there is some doubt about the sample distribution, then the data should be considered ordinal.

๐Ÿ”ธWhen small numbers of observations are being analysed (say, less than 30 observations), it is preferable to consider VAS data as ordinal. 

๐Ÿ”ธFor a number of practical reasons, a VAS is sometimes converted to a 'verbal rating scale', whereby the subject is asked to rate an endpoint on a scale of 0-10 (or 0-5), most commonly recorded as whole numbers. In this situation it is preferable to treat the observations as ordinal data.

๐Ÿ”ธThere has been some controversy in the literature regarding which statistical tests should be used when analysing VAS data. 

๐Ÿ”ธMantha et al surveyed the anaesthetic literature and found that approximately 50% used parametric tests. 

๐Ÿ”ธDexter and Chestnuts used a multiple resampling (of VAS data) method to demonstrate that parametric tests had the greater power to detect differences among groups. 

๐Ÿ”ธMyles et al have recently shown that the VAS has properties consistent with a linear scale, and thus VAS scores can be treated as ratio data. This supports the notion that a change in the VAS score represents a relative change in the magnitude of pain sensation. This enhances its clinical application.

Reference: Statistical Methods for Anaesthesia and Intensive Care, Paul S Myles and Tony Gin