Accuracy of Spinal Anesthesia Drug Concentrations in Mixtures Prepared by Anesthetists.

Heesen, Michael; Steuer, Christian; Wiedemeier, Peter; Schwappach, David (2022). Accuracy of Spinal Anesthesia Drug Concentrations in Mixtures Prepared by Anesthetists. Journal of patient safety, 18(8), e1226-e1230. Wolters Kluwer Health 10.1097/PTS.0000000000001061

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OBJECTIVE

Medication errors include the indirect dosing of drugs. For spinal anesthesia mixtures of local anesthetics, opioids are drawn from ampoules and combined in a syringe, according to clinical practice. We set out to determine the accuracy of the drug mixtures.

METHODS

Physicians of our department were invited to prepare the mixture used for spinal anesthesia for cesarean section, consisting of 10-mg hyperbaric bupivacaine (2-mL volume), 20-μg fentanyl (0.4-mL volume), and 100-μg morphine (0.1-mL volume). Concentrations of these drugs were determined by means of high performance liquid chromatography. Interindividual and intraindividual variations were assessed.

RESULTS

We analyzed 96 samples from 31 physicians. Fifty-one percent of the measured bupivacaine concentrations were in ±10% deviation range of the intended concentration; 17% of the fentanyl and 24% of the morphine concentrations were in this range. A total of 2.1% of the samples had a bupivacaine concentration corresponding to a dose of 8 mg or less, and 11.5% of the samples had a morphine concentration corresponding to a dose of 150 μg or greater. Intraindividual variations were 10.9% for bupivacaine, 24.7% for fentanyl, and 38.9% for morphine.

CONCLUSIONS

Our results show a high deviation of the obtained from the intended concentrations. Two percent of the samples had bupivacaine concentrations that probably resulted into an insufficient analgesia, and 11% of the samples had morphine concentrations that, according to guidelines, would require a longer monitoring period than with the intended dose.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Pre-clinic Human Medicine > Institute of Social and Preventive Medicine (ISPM)

UniBE Contributor:

Schwappach, David

Subjects:

600 Technology > 610 Medicine & health
300 Social sciences, sociology & anthropology > 360 Social problems & social services

ISSN:

1549-8417

Publisher:

Wolters Kluwer Health

Language:

English

Submitter:

Doris Kopp Heim

Date Deposited:

13 Jul 2022 16:07

Last Modified:

08 Jul 2023 00:25

Publisher DOI:

10.1097/PTS.0000000000001061

PubMed ID:

35796585

BORIS DOI:

10.48350/171294

URI:

https://boris.unibe.ch/id/eprint/171294

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