Annales françaises d'anesthèsie et de rèanimation
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Ann Fr Anesth Reanim · May 2009
[Accidental intravenous injection of potassium chloride: analysis of contributing factors and barriers to risk reduction].
Errors linked to injectable potassium chloride (KCl) have been the cause of deaths which have occurred for many years. Following an accidental direct intravenous injection of KCl of no clinical consequence for the patient, we have analyzed the contributive factors, established an action plan to prevent this risk and finally assessed its impact. Among the causes leading to medication errors, we have identified those linked to the handling of the drugs by nurses, the team, the work conditions, the organization, the institutional context and finally to the drug itself. ⋯ The drug supply chain of our institution, as in numerous others, is not safe. Hospitals are not yet organized adequately to prevent the occurrence of such an error. The comparison with foreign organizations of drug dispensation allows us to think that the improvement and professionalization of the drug supply chain will both be assets in the prevention of such medication errors.
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Diagnosis of postoperative myocardial infarction is often difficult, based on tools with a low sensitivity (clinical symptoms, EKG), or with a low specifity (old biomarkers, echocardiographic abnormalities) or inadequate for clinical practice (scintigraphy). Since 1995, clinicians may use more cardiospecific markers (troponin) allowing to modify strategy for postoperative myocardial infarction diagnosis. The aim of this review is to resume such an attitude.
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Ann Fr Anesth Reanim · Apr 2009
Review[Management of transdermal therapeutics in perioperative care].
To provide guidance on perioperative management of most frequently encountered transdermal therapeutics in anaesthesiology: nicotine, fentanyl, nitroglycerin, scopolamine and estradiol. ⋯ The management of transdermal therapeutics in peri operative care can be adapted for each treatment and for each patient by knowing pharmacokinetics as well as anaesthetics and surgical interactions. In emergency situations, the actions to be taken do not generally differ, but one must be aware that the effects of trandermal treatments do not disappear immediately when removed, due to their pharmacokinetics properties.