GENERAL ANESTHESIA 139 Purpose: The objectives of this study were to determine: 1) if anesthesiologists had experienced a medication error and 2) to identify causal factors. The perceived value of a Canadian reporting agency for medication errors and improved standards for labels on drug ampoules was also investigated. Methods: A self-reporting survey was mailed to members of the Canadian Anesthesiologists' Society (n = 2,266). Respondents provided free-text descriptions of medication errors and answered fixed response questions. Results: Surveys from 687 anesthesiologists (30% response rate) revealed that 85% of the participants had experienced at least one drug error or "near miss". Although most errors (1,038) were of minor consequence (98%), four deaths were reported. The commonest error involved the administration of muscle relaxants instead of a reversal agent. "Syringe swaps" (70.4%) and the misidentification of the label (46.8%) were common contributing factors. Anesthesiologists (97.9%) reported that they read the ampoule label "most of the time" although the label colour was an important secondary cue. Approximately half of the participants would report the error if a reporting program existed and 84% agreed that improved standards for drug labels would reduce the incidence of error. Conclusions: Most anesthesiologists experienced at least one drug error. The commonest error was a "syringe swap" that involved a muscle relaxant. Most errors were of minor consequence, however, serious morbidity and mortality resulted from clearly preventable events. These results support the development of improved standards for drug labels and the establishment of a Canadian reporting program for medication errors. Objectif : 1) Découvrir si les anesthésiologistes ont vécu l'expérience d'une erreur de médication et 2) en déterminer les facteurs de causalité. Aussi, on a étudié la valeur perçue d'une agence de notification canadienne des erreurs de médication et de normes strictes des étiquettes d'ampoules de médicaments. Méthode : Une enquête d'autodéclaration a été postée aux membres de la Société canadienne des anesthési-ologistes (n = 2,266). Les répondants ont fourni des descriptions en textes libres des erreurs de médication et ont répondu aux questions à réponses fixes. Résultats : Les réponses reçues de 687 anesthésiologistes (taux de réponse de 30 %) ont révélé que 85 % des participants avaient fait au moins une erreur de médicament ou l'avait évitée de justesse. Même si la plupart des erreurs (1,038) n'ont eu que des conséquences mineures (98 %), quatre décès ont été rapportés. L'erreur la plus fréquente concernait l'administration de myorelaxants à la place de décurarisants. "L'échange de seringue" (70,4 %) et la mauvaise identification de l'étiquette (46,8 %) étaient souvent des causes d'erreur. Certains (97,9 %) ont dit lire l'étiquette sur l'ampoule "la plupart du temps" même si la couleur de l'étiquette était un important signal sec-ondaire. La moitié des participants environ auraient mentionné l'erreur si...

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In this Continuing Professional Development module, we review the practical pharmacology of tranexamic acid and its clinical use in trauma, obstetrics, and major orthopedic surgery. Principal findings Tranexamic acid is a synthetic drug that inhibits fibrinolysis. Multiple clinical trials in various clinical settings have shown that it can reduce blood loss, transfusion rates, and bleeding-associated mortality. In trauma and obstetrical bleeding, early tranexamic acid administration (\ three hours) may have greater clinical benefits. Overall, tranexamic acid use appears safe with no significant increase of thromboembolic or seizure events. Nevertheless, current evidence has limitations related to wide heterogeneity in dose, route, and timing of drug