Medication Errors among Physician-Assistants Anaesthesia

Background. Safety issues in anaesthesia are currently being discussed widely. Anaesthetists have a unique cross-specialty opportunity to influence the safety and quality of patient care. Anaesthetists administer very potent drugs, in rapid succession, during the course of one anaesthesia event. Methodology. The study was done in April 2013 at the annual refresher course of the Physician-Assistants Anaesthesia using a questionnaire which was completed by the participants on the course. The data was analysed using IBM SPSS Statistics software version 20. Results. There were 164 completed questionnaires, with 92 (62.2%) males and 56 (37.8%) females with a mean age of 32.3 years. The majority of them (66.5%) work in government hospitals. One hundred and seven (65.3%) have had an episode of medication error with 101 (94.4%) experiencing it between 1 and 5 times. The incident occurred in the afternoon or at night in 73 (71.7%) cases. The commonest type of incident was the administration of wrong drug which occurred on 64 (71.9%) occasions resulting in 3 deaths. The contributing factors included distraction, tiredness, and overreliance on vial/ampoule colour. Conclusion. Medication errors among Physician-Assistants Anaesthesia are not uncommon leading to harm and even death of patients. The rate of medication errors can be minimised by addressing some of the contributory factors raised by the respondents.

The Use of Lidocaine and Bupivacaine Mix in Adult Safe Male Circumcision: Less Is More

Introduction. Lignocaine is (with or without bupivacaine) the only drug recommended for local anesthesia for safe adult male circumcision (SMC). This study evaluated the effectiveness of postoperative pain control when using two different concentrations. Methods. An observational analytical study conducted at an urban high volume site. Pain was assessed using the Visual Analogue Scale. Mixtures of lignocaine 2%, bupivacaine 0.5% (LiB), and water in ratios of 4 : 4 : 2 and 3 : 3 : 4 were compared. Results. Data from 217 clients were analyzed: 100 in the 4 : 4 : 2 group and 117 in the 3 : 3 : 4 group. Clients in the 4 : 4 : 2 group had more pain, at 60 minutes, compared to the 3 : 3 : 4 group (p=0.035). The 3 : 3 : 4 mix used 70% less lignocaine and 90% less bupivacaine (60 mg and 15 mg); the allowable maximum dosages are 200 mg and 150 mg, respectively. Conclusion. The 3 : 3 : 4 mix was superior to the 4 : 4 : 2 mix. This has implications for supply chain management and potential reduction of LA toxicity. We therefore recommend the 3 : 3 : 4 mix for routine adult SMC.

The Effect of Pulsed Radiofrequency Combined with a Transforaminal Epidural Steroid Injection on Chronic Lumbar Radicular Pain: A Randomized Controlled Trial

Background. Pulsed radiofrequency lesioning (PRFL) of the dorsal root ganglion (DRG) can modulate neural pathways and provide prolonged relief of neuropathic pain, with limited evidence for chronic lumbosacral radicular pain (CLRP). Objective. This study compared the effect of PRFL combined with transforaminal epidural steroid injection (TFESI) to TFESI alone on CLRP. Methods. Forty adults with chronic radicular pain of at least six-month duration were randomly allocated to undergo either a PRFL of the affected DRG followed by a TFESI (treatment group) or a TFESI alone (control group). Participants and assessors were blinded to the allocation and outcomes were assessed at 1, 2, 3, and 4 months. Outcomes. Pain intensity (visual analog score, VAS) was the primary outcome and quality of life (QOL) as measured by the SF-36 was a secondary outcome. Results. There was no difference in baseline characteristics between groups. VAS was significantly lower in the treatment group at 2-month and 3-month but not 4-month follow-up. QOL measurements did not differ between groups. Conclusions. PRFL of the lumbosacral DRG combined with TFESI showed a modest advantage over TFESI alone in reducing pain intensity; however, this did not persist beyond the 3-month follow-up. There was no effect on QOL.

Effect of Low and High Dose Sugammadex on the Coagulation and Fibrinolytic System in Rats

Background. Sugammadex is a new reversal agent that has entered use recently. It is known that with sugammadex some changes in coagulation parameters occur without documented clinical results. Aim of the Work. The objective of this study was to identify effects of sugammadex on liver functions, coagulation, and fibrinolytic systems. Methods. Thirty-six rats were randomized into six groups: Group I, control; Group II, rocuronium group; Group III, sugammadex administered in 16 mg kg−1 dose; Group IV, sugammadex administered in 96 mg kg−1 dose; Group V, rocuronium and sugammadex administered in 16 mg kg−1 dose; and Group VI, rocuronium and sugammadex administered in 96 mg kg−1 dose. After 120 minutes, blood samples were obtained for prothrombin time, activated partial thromboplastin time, D-dimer, fibrinogen, aspartate aminotransferase, alanine aminotransferase, albumin, platelet, and mean platelet volume analyses. Results. Compared to the control group, in all groups measured parameters did not show any effect from a statistical viewpoint either due to the administered drugs alone or due to interaction effects. Conclusion. The conclusion was reached that administration of sugammadex in rats did not have any significant effect on the fibrinolytic system, coagulation parameters, and liver function.

Effect of Normal Saline Bicarbonate on Reversing Epidural Anesthesia Either with Bupivacaine Or Bupivacaine and Nalbuphine in Patients Undergoing Orthopedic Surgery

Background. Orthopedic procedures are among the commonest surgeries in the elderly. On the other hand, those patients have many risk factors suitable for development of postoperative complication due to prolonged postoperative recumbent that decrease by using anesthesia technique allowed early ambulation as far as possible. Aim of the Work. The aim of this study was to evaluate whether washout of the local anesthesia with 0.9% normal saline with bicarbonate through the epidural catheter could provide early ambulation throughout the faster recovery of the motor block. Patient and Methods. Sixty adult patients were included in this study and divided into three groups. In group I, epidural injection of bupivacaine was carried out without wash (control group). In group II, epidural injection of bupivacaine was followed by wash. In group III, epidural injection of both bupivacaine and nalbuphine was followed by wash. Results. They were significantly faster in both group II and group III as compared with group I. In group I, sensory recovery was insignificantly faster than the motor recovery. In group II motor recovery was significantly faster than sensory recovery. In group III motor recovery was significantly faster than the sensory recovery. Conclusions. These results suggested that early ambulation with an adequate postoperative analgesia was reported in patient receiving epidural injection of both bupivacaine and nalbuphine.

Mutations in Sodium Channel Gene SCN9A and the Pain Perception Disorders

Voltage-gated sodium channels (NaV) play a crucial role in development and propagation of action potentials in neurons and muscle cells. NaV1.7 channels take a special place in modern science since it is believed that they contribute to nerve hyperexcitability. Mutations of the gene SCN9A, which codes the α subunit of NaV1.7 channels, are associated with pain perception disorders (primary erythermalgia, congenital analgesia, and paroxysmal pain disorder). It is considered that the SCN9A gene mutations may cause variations in sensitivity to pain, from complete insensitivity to extreme sensitivity. Further research of the SCN9A gene polymorphism influence on pain sensitivity is essential for the understanding of the pathophysiology of pain and the development of the appropriate targeted pain treatment.

Pediatric Resuscitation: Outcome Effects of Location, Intervention, and Duration

Cardiopulmonary resuscitation (CPR) is performed in order to restore oxygen delivery and prevent multiorgan system failure and death. Prompt initiation of CPR with appropriate medical or surgical therapy may shorten arrest duration before irreversible organ injury occurs. The brain is most susceptible to irreversible anoxic injury. Survival data suggests that children are more likely than adults to survive and have good neurologic outcomes following cardiac arrest. In this review of pediatric resuscitation, we discuss important predictors of postarrest outcomes as well as advances in resuscitation science focusing on the critical importance of oxygen delivery during periarrest care.

Comparison of 0.1% Ropivacaine-Fentanyl with 0.1% Bupivacaine-Fentanyl Epidurally for Labour Analgesia

Ropivacaine is an alternative to epidural bupivacaine, with greater selectivity for sensory fibres than motor fibres, thus producing less motor blockade as compared to bupivacaine. The purpose of this study was to evaluate the efficacy of Ropivacaine 0.1% when administered epidurally for the relief of labour pain and to compare it with 0.1% bupivacaine, conducted at Rajindra Hospital Patiala, Baba Farid University of Health and Sciences, on 20 parturients after ethical approval from the institutional review board and obtaining written informed consent. Participants were randomly allocated to the two groups (bupivacaine 0.1% (Sensorcaine) + fentanyl 20 μg versus ropivacaine 0.1% (Ropin) + fentanyl 20 μg). It was observed that ropivacaine 0.1% and bupivacaine 0.1%, with fentanyl 20 μg/mL, produced equivalent analgesia for labour. There were no statistically significant differences in the amount of local anaesthetic used, pain scores, sensory levels, motor blockade, labour duration, mode of delivery, and side effects or patient satisfaction amongst the two local anaesthetics using the intermittent top-up technique. We conclude that the combinations of ropivacaine or bupivacaine with fentanyl achieve equally effective and excellent labour analgesia with no motor blockade and without jeopardizing the safety of the mother and foetus and, hence, are recommended for labour analgesia.

Epidural Anesthesia-Analgesia and Patient Outcomes: A Perspective

The use of perioperative epidural anesthesia-analgesia may confer many benefits including superior postoperative analgesia, decreased morbidity, and improvement in patient-centered outcomes. We will review our group’s work on perioperative epidural anesthesia-analgesia on patient outcomes and discuss future research in this area

Outcomes Research in Perioperative Medicine

Outcomes research is emerging as an invaluable approach to the scientific evaluation of healthcare in a real-world rather than an experimental environment. There is much interest in the differential evaluation of existing interventions with regard to different patient populations. Moreover, various comorbid conditions necessitate analysis for the specific additional risk those factors convey in the perioperative arena, a task often difficult to accomplish without population-based techniques. The authors' group has conducted significant work in perioperative outcomes research utilizing CER and database analysis methodology, with focus on orthopedic surgery and anesthesiology. Our research resulted in numerous publications affecting policy and patient care over the last number of years. Knowledge on immediate perioperative outcomes of anesthesia and surgery is of very high interest not only to clinicians but also to administrators and policymakers, as it allows for risk assessment and allocation of resources. This review is not intended to be a systematic review but rather to (1) provide a brief overview over the theoretical basis of CER and population-based database research, (2) give an overview of our work with various points of focus, and (3) offer a perspective on the future development in perioperative medicine.