Accidental tenfold overdose of propofol in a 6-month old infant undergoing elective craniosynostosis repair

Preventing Medication Errors in Pediatric Anesthesia: A Systematic Scoping Review

OBJECTIVE

Preventing medication errors and improving patient safety in pediatric anesthesia are top priorities. This systematic scoping review was conducted to identify and summarize reports on medication errors in pediatric anesthesia. The study also aimed to qualitatively synthesize medication error situations in pediatric anesthesia and recommendations to eliminate/minimize them.

METHODS

The databases: Cochrane, MEDLINE through PubMed, Embase, CINAHL through EBSCO, and PsycINFO were extensively searched from their inception to March 3, 2020. Error situations in pediatric anesthesia and recommendations to minimize/reduce these errors were synthesized qualitatively. Recommendations were graded by level of evidence using the methodology of the Joanna Briggs Institute.

RESULTS

Data were extracted from 39 publications. Dosing errors were the most commonly reported. Scenarios representing medication (n = 33) error situations in pediatric anesthesia and recommendations to eliminate/minimize medication errors (n = 36) were qualitatively synthesized. Of the recommendations, 2 (5.6%) were related to manufacture, 4 (11.1%) were related to policy, 1 (2.8%) was related to presentation to user, 1 (2.8%) was related to process tools, 17 (47.2%) were related to administration, 3 (8.3%) were related to recording/documentation, and 8 (22.2%) recommendations were classified as others. Of those, 29 (80.6%), 3 (8.3%), 3 (8.3%), and 1 (2.8%) were graded as evidence level 1, 2, 3, and 5, respectively.

DISCUSSION

Medication error situations that might occur in pediatric anesthesia and recommendations on how to eliminate/minimize medication errors were also qualitatively synthesized. Adherence to recommendations might reduce the incidence of medication errors in pediatric anesthesia.

Hypotensive anesthesia versus normotensive anesthesia during major maxillofacial surgery: a review of the literature

Steady blood pressure within normal limits during surgery is one of the markers of the ideal and skillful anesthesia. Yet, reduced blood pressure is advantageous in some settings because it can contribute to a reduction in overall blood loss and improve the surgical field conditions. Controlled hypotension during anesthesia or hypotensive anesthesia is often used in major maxillofacial operations. Since hypotensive anesthesia carries the risk of hypoperfusion to important organs and tissues, mainly the brain, heart, and kidneys, it cannot be applied safely in all patients. In this paper we review the medical literature regarding hypotensive anesthesia during major maxillofacial surgery, the means to achieve it, and the risks and benefits of this technique, in comparison to normotensive anesthesia.

Blood gas partition coefficient and pulmonary extraction ratio for propofol in goats and pigs

The interpretation of continuously measured propofol concentration in respiratory gas demands knowledge about the blood gas partition coefficient and pulmonary extraction ratio for propofol. In the present investigation we compared both variables for propofol between goats and pigs during a propofol anaesthesia. In ten goats and ten pigs, expired alveolar gas and arterial and mixed venous blood samples were simultaneously drawn during total intravenous anaesthesia with propofol. The blood gas partition coefficient and pulmonary extraction ratio were calculated for both species. Non-parametric methods were used for statistical inference. The blood gas partition coefficient ranged between 7000 and 646,000 for goats and between 17,000 and 267,000 for pigs. The pulmonary extraction ratio ranged between 32.9% and 98.1% for goats and was higher for pigs, which ranged between -106.0% and 39.0%. The blood gas partition coefficient for propofol exceeded those for other known anaesthetic compounds so that it takes longer to develop a steady-state. The different pulmonary extraction rates in two species suggest that there are different ways to distribute propofol during the lung passage on its way from the blood to breathing gas. This species-specific difference has to be considered for methods using the alveolar gas for monitoring the propofol concentration in plasma.