Medication errors in anaesthetic practice: a report of two cases and review of the literature

Background: Mistakes in the identification and administration of drugs may be fatal. This is especially so in the practice of anaesthesia. This is a report of 2 cases of near fatality due to mistakes in drug administration from look-alike medications. Objective: To highlight the significance of medication errors in our practice and to discuss the best methods of prevention. Method: A report of two cases of errors in the administration of drugs during the conduct of anaesthesia. The subsequent management of the cases is presented, and the findings from the literature are discussed. Result: In case 1, an adult male presented for herniorrhaphy and after induction with propofol 1mg/kg intravenously, Pancuronium bromide injection 4mg was administered intravenously, in the place of suxamethonium chloride injection. In case 2, For induction of anaesthesia, 100mg of thiopentone sodium was administered in place of 25mg of the same drug because Thiopentone 1gm vial was mistaken for Thiopentone 500mg vial in a 2 year old girl. In both cases, the errors were detected early and there were no adverse sequelae. Conclusion: Medication errors are a potential source of iatrogenic harm to patients undergoing anaesthesia. Strict adherence to principles as well as constant vigilance would minimize this problem

Pattern of postoperative pain management among adult surgical patients in a low-resource setting

Elizabeth Ogboli-Nwasor,1 Sa’adatu T Sule,2 Lazarus MD Yusufu31Department of Anaesthesia, Ahmadu Bello University Teaching Hospital, Zaria, Nigeria; 2Department of Obstetrics and Gynaecology, Ahmadu Bello University Teaching Hospital, Zaria, Nigeria; 3Department of Surgery, Ahmadu Bello University Teaching Hospital, Zaria, NigeriaObjective: Postoperative pain is one of the most common complications of surgery. The pattern of management varies between centers. The current study aimed to study the prescription pattern and the common drugs used in the management of postoperative pain in adult surgical patients at Ahmadu Bello University Teaching Hospital (ABUTH; Zaria, Nigeria).Methods: Following ethical approval, a prospective observational study of consecutive adult patients who had surgery at the ABUTH Zaria was performed from January to December 2005. The data were entered into a proforma and analyzed using the Minitab statistical package.Results: One hundred and thirty-eight patients were included in the study. The age range was 17 to 80 years, with a mean age of 41 years. One hundred and thirty-two (95.7%) of the prescriptions were written solely by the surgeon or surgical resident; passive suggestions were given by the anesthetists for only six patients (4.3%). Intermittent intramuscular injections of opioids/opiates were prescribed for 126 patients (91.3%), while nine patients (6.5%) received intermittent intramuscular injections with non-steroidal anti-inflammatory drugs. Oral paracetamol was prescribed for six patients (4.3%), while three patients (2.1%) received no postoperative analgesic. Moderate pain was recorded in 48 patients (34.8%), and 90 patients (65.2%) had mild pain 8 hours after their operation before subsequent doses of analgesics were given. More females (81 patients [58.7%]), than males (42 patients [29.7%]) suffered moderate to severe pain. The reported side effects were nausea (reported by 32.6% of patients), dry mouth (21.7%), vomiting (13.0%), and urinary retention (6.5%), with 32.6% of patients experiencing no side effects. The three patients who received no analgesics experienced vomiting as a side effect. Despite the high incidence of pain and other side effects, 108 patients (78.2%) still reported that the methods of postoperative pain management were satisfactory.Conclusion: Despite recent advances and the development of more effective techniques for postoperative pain control, a high proportion of patients still experience moderate to severe postoperative pain. Intermittent intramuscular injection of analgesic medication remains the mainstay of postoperative pain management at the ABUTH Zaria. Anesthetists should be more involved in postoperative analgesia prescriptions and should include other forms of multimodal pain management in their regimens. With proper application of current knowledge and training, postoperative pain management can be improved.Keywords: postoperative, pain management, adult surger

Pain relief in labor: a survey of awareness, attitude, and practice of health care providers in Zaria, Nigeria

E Ogboli-Nwasor1, SE Adaji2, SB Bature2, OS Shittu21Department of Anesthesia, 2Department of Obstetrics and Gynecology, Ahmadu Bello University Teaching Hospital, Zaria, NigeriaBackground: The purpose of this study was to assess the attitudes of maternal health care providers to pain relief during labor in Zaria, Nigeria.Methods: This was a multicenter, collaborative, cross-sectional pilot study of provider perspectives concerning pain relief during labor. A structured, self-administered, questionnaire was completed by 95 consenting maternal health care providers at three high-volume facilities in Zaria, an ancient northern Nigerian city. Descriptive statistics was performed on the data.Results: Most respondents (94.8%) agreed that pain relief is needed during labor. Only 2.1% of respondents were undecided about the provision of pain relief during labor and 3.2% were of the opinion that pain relief was not necessary during labor. Most respondents (93.7%) had attended a woman in labor in the 4 weeks preceding the survey. Of these, 56.8% had counseled a parturient in labor. Most of the counseling (42.1%) took place during labor. Less than half of the respondents (48.4%) had administered pain relief in labor in the preceding 4 weeks and systemic opioids was the most commonly form of pain relief. Among the respondents who did not offer pain relief agents in labor, the majority (54.5%) had no reason for not offering it. Unavailability of methods, inability to afford the cost of pain relief, lack of knowledge and skills, as well as lack of essential equipment to provide the procedure were also given by respondents as reasons for not offering pain relief.Conclusion: Even though maternal health care providers in this environment have a positive attitude to pain relief in labor, most women go through labor without the benefit of analgesia. There exists a gap between provider attitudes to pain relief in labor and practice of the same, with many providers having no genuine reason(s) for not offering pain relief to their clients during labor. Providers need to align their practice to their attitudes, and need to be helped to do this through training as well as enhancing their ability to think critically about their practice.Keywords: pain relief, providers, attitudes, practice, labor, conflic