Drug Errors in Anesthetic Practice

Abstract

Anesthetist is personally responsible for all steps of drug administration. Incidence of drug errors in anesthesia is attributed primarily to human errors due to haste, distractions, fatigue, high workloads and lack of experience. Complexity of surgical procedures and comorbidities may increase error rates. Most drug errors cause little or no harm; however there is the potential of significant morbidity or mortality. Drug administration process includes giving the right drug, through the right route, in the right dose, on the right time, and to the right patient. Syringe or drug preparation errors mean that the incorrect syringe or ampoule or concentration was given instead of the desired one. Accidental injection of wrong drug into the subarachnoid space can result in devastating neurological consequences. Spinal lavage benefits by removing and diluting the injected drug thus helping in limiting the neurological damage. Route of administration errors include: extravasation injuries, accidental intra-arterial injection and accidental intravenous injection. Extravasation and accidental intra-arterial injection may cause significant permanent tissue injury. Prompt management improves outcome and specific management strategies reduce long term damage. Infusion of lipid emulsions is highly efficacious in treating cardiovascular toxicity of local anesthetics that occurs when the accepted blood levels are exceeded due to accidental intravenous injection or slow absorption of a large volume of extra vascular local anesthetic.Dosage errors results from wrong drug adjustment according to the patient's age, body weight, sex and drug interactions. Poor communication between anesthetic staff can produce drug errors the same as equipment misuse or malfunction that commonly involves anesthesia machines, vaporizers and intravenous infusion pump.