August 22, 2010

In the September 2010 BJA …

Prevention of drug errors

Errors in drug administration, either the wrong drug or the wrong dose of the right drug, remain a problem in anaesthesia with an incidence as frequent as 1:131 having been reported. It has been proposed that a system of ‘double-checking’ should be introduced to reduce this problem. The feasibility of introducing such a measure was tested in seven hospitals and is reported here (Evley et al., pages 289–96). They evaluated a system of two-person checking and one using an electronic bar-code reader. Both systems were perceived as improving safety. However, the cultural changes required and some technical issues will require further work.

Predicting outcomes

The ability to predict outcome in anaesthesia and intensive care at an early stage where intervention may be beneficial is the subject of a number of articles in this month’s BJA. In an Editorial, Grocott and Pearse (pages 243–5) evaluate the status of studies of preoperative risk factors in predicting outcome and highlight a number of problems and the need for large, robustly designed studies in this area. The value of CPET was retrospectively reviewed in 847 patients undergoing major abdominal surgery (Wilson et al., pages 297–303) and found to be better than the use of clinical risk factors alone in identifying ‘at risk’ patients. In contrast, two studies in intensive care found poor prognostic value of C-reactive protein as a predictor of outcome (Al-Subaie et al., pages 318–25) in ICU and, similarly, simple ventilation/gas exchange measures were poor predictors of successful weaning in ICU (Monaco et al., pages 326–33).

New i.v. anaesthetic agents

It seems to have been quite some time since any new i.v. anaesthetic agents were introduced. While the agents we use at present are good, they are not without limitations. There are now a number of hypnotics, whose structures are based on familiar agents, undergoing evaluation. Their structures, pharmacology and current status of development are reviewed by Sneyd and Rigby-Jones (pages 246–54). Some of these agents are now reaching the stage of clinical studies.