Articles: anesthetics.
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Randomized Controlled Trial Multicenter Study
Dilute proparacaine for the management of acute corneal injuries in the emergency department.
Dogma discourages the provision of topical anesthetics to patients with corneal injuries discharged from the emergency department because of the toxicity of concentrated solutions. We compared the analgesic efficacy of dilute topical proparacaine with placebo in emergency department patients with acute corneal injuries. ⋯ Dilute topical proparacaine is an efficacious analgesic for acute corneal injuries. Although no adverse events were observed in our study population, larger studies are required to evaluate safety.
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Multicenter Study
Confirming the drugs administered during anaesthesia: a feasibility study in the pilot National Health Service sites, UK.
To help prevent drug errors, it is recommended that drugs should be confirmed/checked with a second person before administration. We aimed to assess the feasibility of introducing second-person or electronic bar-code confirmation of drugs, administered during anaesthesia, in the National Health Service (NHS) settings in the UK. ⋯ The introduction of two-person confirmation to the NHS would have a significant impact on the existing working practices. Issues related to resources and a cultural change will need to be addressed. Electronic confirmation was more feasible, but the technological aspects of its integration into the operating theatre environment, and learning, will require further attention.
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Multicenter Study
The Thai Anesthesia Incident Monitoring Study (Thai AIMS): an analysis of perioperative complication in geriatric patients.
The present study was a part of the multi-centered study of model of Anesthesia related adverse events in Thailand by incident report. (The Thai Anesthesia Incident Monitoring Study or Thai AIMS). The objective of the present study was to identify and analyze anesthesia incident in geriatric patients in order to find out the frequency distribution, clinical courses, management of incidents and investigation of model appropriate for possible corrective strategies. ⋯ Incidents in geriatric patients were similar to all age group patients with a higher incidents in death within 24 hr. The outcome were more serious resulting in 26.5% fatal outcome at 7 days. Quality assurance activity, clinical practice guidelines and improved supervision were suggested corrective strategies.
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Paediatric anaesthesia · Jun 2010
Randomized Controlled Trial Multicenter Study Comparative StudyAirway responses to desflurane during maintenance of anesthesia and recovery in children with laryngeal mask airways.
We sought to characterize the airway responses to desflurane during maintenance of and emergence from anesthesia in children whose airways were supported with laryngeal mask airways (LMAs). ⋯ When an LMA is used during desflurane anesthesia in children, fewer airway events occur when it is removed when the child is awake. Although the time to discharge from recovery was not delayed and no child required overnight admission, caution should be exercised when using an LMA in children who are anesthetized with desflurane.
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Multicenter Study Controlled Clinical Trial
Clinical assessment of a new anaesthetic drug administration system: a prospective, controlled, longitudinal incident monitoring study.
An interesting and thought-provoking study, even with its flaws.
The authors concluded that system changes surrounding anaesthetic drug delivery reduce medication error.
A ‘care bundle’ approach was taken to improve drug safety through system design and human factors considerations:
- Coloured drug labels with barcodes.
- Computerised drug crosscheck.
- Computerised allergy and drug expiration alerts.
- Re-organised anaesthesia workplace, focusing on the drug administration workflow.
- Prefilled syringes for: calcium chloride, ephredrine, fentanyl, lidocaine, magnesium sulphate, metaraminol, midazolam, neostigmine, and pancuronium.
- Automated computerised anaesthetic record.
But the problems...
No randomisation, no blinding, observational study, completely voluntary use of the safety system and self-reporting of errors...
Were the improvements due to the intervention, or simply a greater interest and priority given to anaesthetic safety? (Would it matter?)
In only 15% of anaesthetics was the new system (voluntarily) used, and thus may represent anaesthetists more motivated to prioritise medication safety over convenience or convention.
Finally error is being used (not unreasonably) as a surrogate marker for patient harm. (Although the authors did try to sneak in... “a non-significant reduction (p=0.055) in the harm attributable to drug administration error” 🙄)
Final word of caution
Even this quite impressive system was not immune to error. There were 19 cases of violation of the video and/or audio crosscheck before drug administration. Automated safety systems are obviously no panacea.
Additionally, although there was an observed reduction in all drug errors, there was no reduction specifically in drug substitution error.
Nonetheless a refreshing and novel approach to anaesthetic drug safety, beyond the typical admonishment to just be safer.
More on the system used:
- Webster (2001): The frequency and nature of drug administration error during anaesthesia
- Merry (2001): A new, safety-oriented, integrated drug administration and automated anesthesia record system
- Webster (2004): A prospective, randomised clinical evaluation of a new safety-orientated injectable drug administration system in comparison with conventional methods.