Preoperative preparation of emergency anaesthetic drugs

Abstract

Emergency anaesthetic drugs, are life-saving drugs routinely prepared by the anaesthetist before the start of the operating list. These drugs are discarded and a new batch of drugs is pre-prepared. Such pre-preparation has both advantages and disadvantages. The aim of this study was to describe the practice of anaesthetists at the University of the Witwatersrand’s academic training hospitals with regard to pre-preparation of emergency anaesthetic drugs, to describe the frequency of accidental drug administration and the degree of emergency drug contamination and wastage. Methods A questionnaire on the pre-preparation of emergency anaesthetic drugs was developed and distributed to members of the Department of Anaesthesiology at the three training hospitals of the University of the Witwatersrand. Results The total number of completed questionnaires was 194, giving a response rate of 88.5%. Eighty-four (43.30%) respondents always pre-prepare,101 (52.06%) only sometimes pre-prepare, and eight(4.12%) do not pre-prepare emergency anaesthetic drugs at the start of the list. It has been observed that significantly fewer(34.82%) senior staff always pre-prepare emergency anaesthetic drugs compared to junior staff (58.11%) (p<0.001).Respondents with 0-2 years of experience pre-prepare emergency anaesthetic significantly more than respondents with six or more years of experience(p<0.001). The choice of emergency anaesthetic drugs routinely pre-prepared is dependent on the type of patient and the nature of surgery: elective or emergency surgery. The results showed a significant difference between practice for elective and emergency surgery: a significantly higher number of respondents prepare for succinylcholine, ephedrine, phenylephrine and adrenaline (p=0.002, p=0.013, p=0.035 and p<0.001 respectively) for emergency surgery. The result for atropine was non-significant (p= 0.809). Conclusion The practice of anaesthetists at three of the hospitals varies according to professional grade, nature of surgery and the type of patient. For the type and nature of surgery, the results show that senior staff tend to pre-prepare drugs less frequently than junior staff. Departmental policy would assist to decrease the pre-preparation, and hence wasting of emergency anaesthetic drugs. It would also reduce the incidence of complications arising from their pre-preparation. Introduction of pre-filled syringes for the most commonly used emergency anaesthetic drugs would be recommended to also decrease drug administration error and drug wastage