Apicare Journal May-August 2013; Vol 17(2)
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ORIGINAL ARTICLE – Efficacy and patient acceptability of analgesia by intranasal diamorphine in burns patients: results of a pilot project | Anaesthesia, Pain & Intensive Care

ORIGINAL ARTICLE – Efficacy and patient acceptability of analgesia by intranasal diamorphine in burns patients: results of a pilot project | Anaesthesia, Pain & Intensive Care | Apicare Journal May-August 2013; Vol 17(2) | Scoop.it
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Muhammad Adil Abbas Khan*, Thomas Reekie**, R Breakey***, Mark Gorman**, Mritunjay Kumar Varma****, Simon Law****

*Specialist Registrar, **Core Trainee, ***House Officer

Department of Plastic, Reconstructive & Burns Surgery

****Consultant Anaesthetist

University Hospital of North Durham, Durham, United Kingdom DH1 5TW

Correspondence: Dr. Muhammad Adil Abbas Khan, 10 Harvey Lodge, Admiral Walk, London W9 3TH (UK); Mobile: 07863332517; E-mail: adilaku@hotmail.com

ABSTRACT

Objective: To objectively assess intranasal diamorphine as an analgesic adjuvant for change of dressings in burn patients.

Methodology: Eleven patients were recruited at a regional burns centre for this pilot study. Intranasal diamorphine at a weight-calculated dose was administered through an atomizer and patient vital signs and APVU scores were documented pre and post administration. A post-procedural satisfaction questionnaire was also completed by all patients.

Results: Eleven patients (8 males and 3 females) were recruited for this pilot project. Mean age was 34 years (19-57 years) and mean burn total body surface area (TBSA) was 8.9% (4-17%). Procedure duration was a mean of 53.0 minutes (30-72 minutes). Six of the patients had a past history of opiate use. The data of our small-scale study shows that it has good analgesic efficacy, rapid-onset, safety and high degree of patient satisfaction without the need for intravenous access. There were no side-effects and all patients expressed satisfaction with the analgesia given.

Conclusion: Intranasal diamorphine provides effective analgesia for moderate to severe procedural pain and can be a safe analgesic adjuvant for change of dressings in burn patients.

Key words: Intranasal diamorphine; Total body surface area; Burn; Burn Unit; Analgesia

Khan MAA, Reekie TA, Breakey R, Gorman M, Varma MK, Law S. Efficacy and patient acceptability of analgesia by intranasal diamorphine in burns patients: results of a pilot project. Anaesth Pain & Intensive Care 2013;17(2):128-130

 
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SPECIAL ARTICLE – Medical errors related to look-alike and sound-alike drugs | Anaesthesia, Pain & Intensive Care

SPECIAL ARTICLE – Medical errors related to look-alike and sound-alike drugs | Anaesthesia, Pain & Intensive Care | Apicare Journal May-August 2013; Vol 17(2) | Scoop.it
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Samina Ismail, FCPS*, Arshad Taqi, FCPS**

*Associate Professor, Department of Anesthesia, Aga Khan University Hospital, Karachi (Pakistan)

**Consultant Anesthesiologist, Hameed Latif Hospital, Garden Town, Lahore (Pakistan)

Correspondence: Dr. Samina Ismail, Associate Professor, Department of Anaesthesia, Aga Khan University Hospital, Karachi (Pakistan); E-mail: samina.ismail@aku.edu

SUMMARY

Despite recent developments in the inventory management, introduction of electronic drug trolleys and cabinets, color coding of the filled syringes and many more interventions, medication errors could not be eliminated. The most common of these are syringe swap and human errors regarding wrong drug administration due to look-alike drug containers or sound-alike names of the drugs belonging to diverse groups. Many of the fatalities, that occur in third world countries due to these causes, go unnoticed and unregistered. This special article complements two special editorials on the same topic by Professor Joseph D. Tobias et al and Professor Robert Stoelting, a case report, a patient’s perspective and a ‘Cliniquiz’ being published in the current issue of the journal. It discusses salient features of this issue as well as preventive measures.

Key words: Medications; Medications errors; Adverse drug events; Look-alike drugs; Sound-alike drugs Tall man lettering; Medication Errors Reporting Program; Anesthesia Patient Safety Foundation

Citation: Ismail S and Taqi A. Medical errors related to look-alike and sound-alike drugs. Anaesth Pain & Intensive Care 2013;17(2):117-122

 
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EDITORIAL VIEW – Medication errors: A matter of serious concern | Anaesthesia, Pain & Intensive Care

EDITORIAL VIEW – Medication errors: A matter of serious concern | Anaesthesia, Pain & Intensive Care | Apicare Journal May-August 2013; Vol 17(2) | Scoop.it
Apicare Journal's insight:

Joseph D. Tobias, MD*, Ghanshyam Yadav, MD**, Surender Kumar Gupta***, Gaurav Jain, MD, PDCC****

*Chief, Department of Anaesthesiology & Pain Medicine, Nationwide Children’s Hospital, Columbus, Ohio

**Assistant Professor, ***Junior Resident,

Department of Anaesthesiology, Sir Sunder Lal Hospital, Institute of Medical Sciences, BHU, Varanasi, 221005, UP (India).

****Assistant Professor, Department of Anaesthesiology, Teerthankar Mahaveer Medical College, Muradabad, UP, India

Correspondence: Joseph D. Tobias, Nationwide Children’s Hospital, Columbus, Ohio 43205. Joseph.Tobias@Nationwidechildrens.org

ABSTRACT

The incidence of medications errors is increasing and the exact incidence is likely greatly underestimated and under-reported.  Although the majority of these errors occur due to lack of knowledge of or failure to follow accepted protocols, look alike medication containers are the primary cause in many cases of drug error related morbidity or even mortality. With the number of drugs and the number of pharmaceutical companies manufacturing the same drug on an increase, the incidence is likely to increase. It is a universal problem that can be found in any operating room throughout the world, as demonstrated by the multi-national representation of many reports on this subject in the literature. This editorial supplements a case report, the ‘Clinipics®’ page and a special article on the topic of hazards of look-alike drug containers published in this issue of Anaesthsia, Pain & Intensive Care.  The authors also attempt to present strategies to reduce these medication errors. The development of a non-blame environment where errors are openly reported and discussed and regulations for labeling the drug containers, vials and ampoules is stressed.

Key words: Medication errors; Medication Errors/prevention & control; Morbidity; Mortality; Drug containers; Root cause analysis

Citation: Tobias JD, Yadav G, Gupta SK, Jain G. Medication errors: A matter of serious concern. Anaesth Pain & Intensive Care 2013;17(2):111-114

 
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ORIGINAL ARTICLE – A comparative study of the effect of parentral and oral glutamine on biochemical parameters and on the duration of ICU stay in critically ill patients | Anaesthesia, Pain & Inten...

ORIGINAL ARTICLE – A comparative study of the effect of parentral and oral glutamine on biochemical parameters and on the duration of ICU stay in critically ill patients | Anaesthesia, Pain & Inten... | Apicare Journal May-August 2013; Vol 17(2) | Scoop.it
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Dinesh Singh*, Sulekha Saxena**, Jai Shree Bogra***, Ajay Kr. Chaudhary****, Girish Chandra***, Shashi Bhushan***

*Associate Professor, **MD Student, ***Professor, ****Assistant Professor

 Department of Anesthesiology, KG’s Medical University, Lucknow (India).

Correspondence: Dr. Sulekha Saxena, MD Student, Department of Anesthesiology, King George Medical University, Lucknow (India); Cell: 09359618480; E-mail: dr.sulekha2008@rediffmail.com

ABSTRACT

Objective: To study the comparative effects of parenteral and oral glutamine therapy on biochemical parameters and reduction in the hospital stay of critically ill patients.

Study design: Randomized controlled trial.

Study site: Trauma Ventilatory Unit, Trauma Centre, King George Medical University, Lucknow.

Methodology: 120 critically ill patients aged 16-60 years admitted to Trauma Ventilatory Unit, Trauma centre KGMU, Lucknow. The patients were randomly divided into 3 equal groups, 40 in each group: Group A (control group) received no glutamine; Group B received oral glutamine 20 g/d for 5 days and Group C received l-alanyl-l-glutamine dipeptide 0.3 g/kg/d by intravenous infusion for 5 days. Complete blood count was done at regular intervals of 24 hours. Total proteins and serum albumin were recorded at 5 day intervals. Single blinding was done.

Results: The total leukocyte counts (TLC) levels in all the three groups increased after the treatment and the observed  increase was least evident in Group C (18.7%), followed by Group B (32.5%) and it was the highest in Group A (38.2%).  A similar observation was made for CRP and lymphocyte levels in all of the three groups. However, a significant decrease was found in total protein and albumin levels. The mean duration of hospital stay of Group C was the least followed by Group B and Group A.

Conclusion: Parenteral glutamine in a dose of 0.3 g/kg/d was more efficacious than 20 g/d oral glutamine in increasing/decreasing in the biochemical parameters after the therapy. The duration of hospital stay was similar in all the groups after treatment.

Key words: Glutamine; C-reactive protein; CRP; Hospital stay

Citation: Singh D, Saxena S, Bogra JS, Chaudhary AK, Chandra G, Bhushan S. A comparative study of the parenteral and oral glutamine on biochemical parameters and on the duration of ICU stay in critically ill patients. Anaesth Pain & Intensive Care 2013;17(2):123-127

 
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EDITORIAL VIEW – New strategy for severe Legionella pneumonia? | Anaesthesia, Pain & Intensive Care

EDITORIAL VIEW – New strategy for severe Legionella pneumonia? | Anaesthesia, Pain & Intensive Care | Apicare Journal May-August 2013; Vol 17(2) | Scoop.it
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Koji Sumikawa, MD, Hiroaki Morooka, MD, Atsushi Tsuda, MD

Department of Anesthesiology, Saiseikai Nagasaki Hospital, Nagasaki, (Japan)

Correspondence: Koji Sumikawa,MD, Saiseikai Nagasaki Hospital, Nagasaki (Japan); E-mail: sumikawa@nsaisei.or.jp

SUMMARY

Legionella pneumonia is among the top three of microbial causes of community–acquired pneumonia. During the course of illness, respiratory failure, and even multiple organ failure may develop. Morbidity and mortality of patients with Legionella pneumonia has been attributed to an imbalanced immune response yielding organ failure and septic shock. In a case of severe Legionella pneumonia, the hemoperfusion with polymyxin B-immobilized fiber column (PMX) drastically improved the respiratory and hemodynamic states, suggesting that PMX might be a new strategy for severe Legionella pneumonia

Key words: Legionella pneumonia, Acute kidney injury, Polymyxin B-immobilized fiber column , PMX,

Citation: Sumikawa K, Morooka H, Tsuda A. New strategy for severe Legionella pneumonia? Anaesth Pain & Intensive Care 2013;17(2):115-116

 
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INVITED EDITORIAL – The Anesthesia Patient Safety Foundation: Pioneering success in safety but challenges remain | Anaesthesia, Pain & Intensive Care

INVITED EDITORIAL – The Anesthesia Patient Safety Foundation: Pioneering success in safety but challenges remain | Anaesthesia, Pain & Intensive Care | Apicare Journal May-August 2013; Vol 17(2) | Scoop.it
Apicare Journal's insight:

Robert K. Stoelting, MD

President, Anesthesia Patient Safety Foundation

Correspondence: Robert K. Stoelting, MD, President, Anesthesia Patient Safety Foundation, Building One, Suite Two, 8007 South Meridian Street, Indianapolis, IN 46217-2922 (USA); Tel: 317.885.6610;   Fax: 317.888.1482; E-mail: stoelting@apsf.org; Web: www.apsf.org

SUMMARY

The practice of anesthesiology has emerged as a science as well as an art, which has made heroic surgical interventions possible, for example surgery on a heart with severely compromised myocardium and heart and liver transplantation etc. The constant struggle to remove the risks and adverse outcome during the conduct of anesthesia has led a stream of protocols and guidelines. The Anesthesia Patient Safety Foundation (APSF), created in 1985, is a step forward to create awareness about safety as well as present practical measures to enhance safety all around the globe. This editorial highlights the vital role being played by APSF regarding anesthesia safety.

Key words:  Anesthesia safety; Patient safety; Anesthesia Patient Safety Foundation; APSF; Simulation; Automated Information Systems; Evidenced-Based Medicine; ASA

Citation: Stoelting RK. The Anesthesia Patient Safety Foundation: Pioneering success in safety but challenges remain. Anaesth Pain & Intensive Care 2013;17(2):109-110

 
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