When given at induction of anesthesia, 50 mg intravenous dolasetron is equivalent to 4 mg ondansetron and superior to 25 mg dolasetron and placebo for the prevention of PONV. All treatments were safely administered and well tolerated.
SummaryThe aim of this study was to assess the impact of differences in drug label information on injectable drug selection errors. Differences in the display of drug strength information were assessed in a randomised controlled trial involving ward nurses, intensive care nurses, nurse anaesthetists, ward physicians, and anaesthetists. A set of 24 on-screen tasks were constructed. For each task, a label corresponding to an instruction consisting of two from three possible pieces of information (concentration, quantity, volume) had to be selected from a list of 10 items. The set was presented three times to participants using three different label formats. Format A provided two pieces of strength information different from those in the instruction. Format B and C provided all three pieces in a random and a fixed sequence, respectively. The frequency of errors was statistically higher with formats A and B than with format C, and greater in nurses than in anaesthetists. Regulatory bodies should therefore implement a standard requiring that the concentration (expressed in 'mg.ml Incorporating safety into the design of healthcare systems is essential for the prevention of medical errors [1]. In practice, however, many hospital care processes have not been designed for safety. Rather, they have developed over time and often contain intrinsic system weaknesses. One example is the design of drug labels. Labels represent the main 'drug ⁄ user' interface, and numerous case reports [2,3] suggest that their characteristics, such as the drug name, type-face, colour coding or expression of drug strength greatly contribute to the incidence of medication errors. However, the impact of drug label design on human performance has received little attention. Studies have shown that print characteristics affect the readability of labels [4,5], and that orthographic and phonetic similarity between drug names increases the probability of a false recognition error [6]. Printing a section of a drug name in capital letters has been shown to reduce errors in drug name recognition [7,8].As calculation errors are common amongst healthcare professionals [9][10][11], several authors have advised that the display of drug strength information on injectable medication labels be standardised [10,12]. To understand the potential impact of this measure on human reliability, we designed a computer-based experiment to compare the effect of three different drug strength information formats, incorporating various levels of standardisation, on the frequency of drug selection errors made by groups of healthcare professionals. Methods Study populationFive different professional groups (ward nurses, intensivecare nurses, nurse anaesthetists, ward physicians, anaesthetists) each group consisting of 15 volunteers, were involved in the experiment. The volunteers, who were recruited in the institution by an advertising campaign, were informed of the aim and design of the study, gave their written consent, and received monetary compensation of approximately €15....
The course of arterial to end-tidal carbon dioxide tension difference [P(a-ET)CO2] was evaluated during general anesthesia in 25 patients scheduled for renal surgery performed in the "kidney position." The difference between arterial PCO2 (PaCO2) corrected to body temperature, and end-tidal PCO2 (PETCO2) measured by mass spectrometry was assessed after induction of anesthesia, after placement in the lateral decubitus position with back arched over a kidney bridge ("kidney position"), and every 20 min until the patients were replaced in the supine position at the end of the surgical procedure. Heart rate, arterial blood pressure, and esophageal temperature were simultaneously recorded. After induction of anesthesia, when the patients were lying supine (T1), P(a-ET)CO2 was 4.8 +/- 3.9 mm Hg (mean +/- SD). Placing the patients in the kidney position (T2) induced a significant increase in P(a-ET)CO2 (to 7.9 +/- 3.5 mm Hg; P less than 0.01). These alterations occurred without any significant change in mean arterial blood pressure or heart rate. A progressive increase in mean P(a-ET)CO2 occurred with maintenance of anesthesia; P(a-ET)CO2 reached 8.8 +/- 4.1 mm Hg (P less than 0.05 vs T2) and 8.9 +/- 4.4 mm Hg (P less than 0.05 vs T2) at 65 and 85 min, respectively, after lateral decubitus positioning. Large variations between and within patients were observed. Although stable mean arterial pressure was maintained, these changes were associated with a significant decrease in body temperature. These results demonstrate that P(a-ET)CO2 increases when patients are placed in the kidney position and may vary with the prolongation of anesthesia in this situation.(ABSTRACT TRUNCATED AT 250 WORDS)
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