Drug mixtures and infusion technology

Allison, Ella W.; Malherbe, Stephan; Barker, Nigel

doi:10.1111/anae.15694

Cited by 3 publications

(2 citation statements)

References 4 publications

(5 reference statements)

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“…O'Connor et al previously pointed to the incompatibility of propofol and remifentanil as the mixture does not remain homogenous, undergoing separation and layering as the remifentanil concentration rises [5]. The clinical implications of this have been challenged with bench-top studies which, obviously, do not replicate everyday preparations [6].…”

Section: Handling Injectable Medications: Mixing Drugsmentioning

confidence: 99%

Handling injectable medications: mixing drugs

Murphy,

Stewart,

Nestor

et al. 2024

Anaesthesia

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Equally most left-handers easily adapt to living in a righthanded world and already satisfactorily intubate patients' tracheas with the exact same equipment as right-handers.Right-handed syringe labelling provides optimal readability when injecting with the right hand and, as the guidelines emphasise value of standardisation when team-working, this will importantly facilitate any double-checker reading the label immediately before injection when right-handed anaesthetists will almost always present the syringe ergonomically held in their right hand.Making standardisation of practice for syringe labelling and handling part of the curriculum for training anaesthetists is an excellent proposal and supporting this it would seem appropriate to try and remove any unnecessary ambiguities from the process. This arrangement could be included in the recommended departmental and institutional policies.

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Section: Handling Injectable Medications: Mixing Drugsmentioning

confidence: 99%

Handling injectable medications: mixing drugs

Murphy,

Stewart,

Nestor

et al. 2024

Anaesthesia

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“…An international survey carried out by our department did identify additional effort (52% of infrequent users) as a significant barrier to using TIVA. Reducing the required infusions from two to one may marginally decrease the set-up time, the reason this practice is promoted by Allison et al for facilitating the benefits of TIVA in their fast turnover paediatric lists [6]. We use TIVA exclusively in our practice and do not find this to be a problem in high-turnover lists.…”

mentioning

confidence: 99%

Drug mixtures and infusion technology: replies

2022

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Many drugs given to children are not licensed for the particular indication, age or route of administration, because the manufacturer has not applied to the Licensing Authority for a Marketing Authorisation in paediatrics. In 2007, European law introduced a requirement for pharmaceutical companies to undertake studies in children as part of the development plan for most new medicines so, although this may change, out of necessity the use of unlicensed medication in paediatric anaesthesia is still common. The practice of combining remifentanil and propofol, which Bagshaw et al. defend [1], is not commonplace or accepted practice in adult anaesthesia, nor are we aware of any national or international guidelines/consensus statements condoning this. In the Association of Anaesthetists' guideline for the safe administration of total intravenous anaesthesia, which Bagshaw co-authored, remifentanil infusions are directed to be given by target-controlled or manual infusion for smaller children. It also cautions that those aged < 8 y tend to be less sensitive to its effects, and suggest diluting remifentanil to a single, standard concentration [2]. Using a fixed admixture with propofol will not allow titration of the analgesic effects without also altering the depth of anaesthesia and this may be dose dependent. Given the 838

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Carbon footprint of inhalation and total intravenous anaesthesia for paediatric anaesthesia: a modelling study. Comment on Br J Anaesth 2022; 129: 231–43

Kantsedikas

Brooks

2023

British Journal of Anaesthesia

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Drug mixtures and infusion technology

Cited by 3 publications

References 4 publications

Handling injectable medications: mixing drugs

Handling injectable medications: mixing drugs

Drug mixtures and infusion technology: replies

Carbon footprint of inhalation and total intravenous anaesthesia for paediatric anaesthesia: a modelling study. Comment on Br J Anaesth 2022; 129: 231–43

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