Errors in drug administration by anaesthetists in public hospitals in the Free State

Objective. To investigate errors in administering drugs by anaesthetists working in public hospitals in the Free State province. Methods. Anonymous questionnaires were distributed to doctors performing anaesthesia in public hospitals in the Free State, i.e. 188 doctors at 22 public sector hospitals. Outcomes included demographic information on respondents, information regarding the administration of anaesthetics, reporting of errors, and the occurrence of errors during anaesthesia. Results. The response rate was 46.3%; 48.8% were medical officers, and 39.3% of participants were involved in at least one event of erroneous drug administration. Registrars and specialists reported the most errors. Most events were of no clinical significance, caused no permanent harm to patients, and most commonly involved fentanyl and suxamethonium. Of the respondents, 23.8% indicated that they were aware of a South African standard for colour-coding syringe labels, and 92.9% indicated that they would report anaesthetic errors if a single reporting agency for such events existed. Conclusions. More than a third of participating anaesthetists were involved in a drug error at some stage in their practice. Preventive systems and precautionary measures should be put in place to reduce drug administration errors

Editorial: Paediatric dental sedation: Will your child return home unharmed?

No Abstrac

Calculation of comparative utilisation and cost: a South African perspective on intravenous vs. inhalational anaesthesia for procedures of differing duration

Objectives: The cost of various anaesthetic techniques fluctuates and is seldom transparent, because of complicated anaesthetic protocols. The theoretical costs of different anaesthetic techniques were compared in this study.Design: This comparative study utilised protocols that determined the cost of inhalational anaesthesia, based on evidence from relevant literature. Propofol target-controlled infusion (TCI) was used as the intravenous protocol [Alaris® PK syringe pump (Schnider model), Cardinal Health, UK].Setting and subjects: No patients were involved in this theoretical cost analysis.Outcome measures: The calculated costs of high- vs. low-flow inhalational anaesthesia and inhalation vs. intravenous anaesthesia with propofol, with or without N2O, and procedures of a longer and shorter duration were compared.Results: Trends were noted. High-flow inhalational anaesthesia tended to be more expensive than low-flow inhalational anaesthesia. The savings that were gained by implementing low-flow anaesthesia increased with the duration of procedure. The savings were greater when less soluble inhaled anaesthetics were used. Isoflurane and halothane anaesthesia cost more when N2O was added. Inhalational anaesthesia with isoflurane was the most cost-effective option consistently. Anaesthesia with desflurane was always the most expensive option. Propofol TCI was less expensive than sevoflurane for long procedures.Conclusion: Anaesthetic drugs account for only 3-4% of the total cost of a surgical procedure, but economic use thereof frees up resources for other essentials in financially challenging times. Isoflurane should be used widely. N2O should probably be used conservatively as it increases the anaesthetic cost and contributes to pollution and ozone depletion. Propofol TCI can be considered instead of sevoflurane inhalational anaesthesia for longer procedures.Keywords: cost of anaesthesia; inhalational anaesthesia, intravenous anaesthesia, nitrous oxideSouth Afr J Anaesth Analg 2012;18(6):310-31

Maternal and neonatal outcomes after caesarean delivery in the African Surgical Outcomes Study: a 7-day prospective observational cohort study.

BACKGROUND: Maternal and neonatal mortality is high in Africa, but few large, prospective studies have been done to investigate the risk factors associated with these poor maternal and neonatal outcomes. METHODS: A 7-day, international, prospective, observational cohort study was done in patients having caesarean delivery in 183 hospitals across 22 countries in Africa. The inclusion criteria were all consecutive patients (aged ≥18 years) admitted to participating centres having elective and non-elective caesarean delivery during the 7-day study cohort period. To ensure a representative sample, each hospital had to provide data for 90% of the eligible patients during the recruitment week. The primary outcome was in-hospital maternal mortality and complications, which were assessed by local investigators. The study was registered on the South African National Health Research Database, number KZ_2015RP7_22, and on ClinicalTrials.gov, number NCT03044899. FINDINGS: Between February, 2016, and May, 2016, 3792 patients were recruited from hospitals across Africa. 3685 were included in the postoperative complications analysis (107 missing data) and 3684 were included in the maternal mortality analysis (108 missing data). These hospitals had a combined number of specialist surgeons, obstetricians, and anaesthetists totalling 0·7 per 100 000 population (IQR 0·2-2·0). Maternal mortality was 20 (0·5%) of 3684 patients (95% CI 0·3-0·8). Complications occurred in 633 (17·4%) of 3636 mothers (16·2-18·6), which were predominantly severe intraoperative and postoperative bleeding (136 [3·8%] of 3612 mothers). Maternal mortality was independently associated with a preoperative presentation of placenta praevia, placental abruption, ruptured uterus, antepartum haemorrhage (odds ratio 4·47 [95% CI 1·46-13·65]), and perioperative severe obstetric haemorrhage (5·87 [1·99-17·34]) or anaesthesia complications (11·47 (1·20-109·20]). Neonatal mortality was 153 (4·4%) of 3506 infants (95% CI 3·7-5·0). INTERPRETATION: Maternal mortality after caesarean delivery in Africa is 50 times higher than that of high-income countries and is driven by peripartum haemorrhage and anaesthesia complications. Neonatal mortality is double the global average. Early identification and appropriate management of mothers at risk of peripartum haemorrhage might improve maternal and neonatal outcomes in Africa. FUNDING: Medical Research Council of South Africa.Medical Research Council of South Africa