BACKGROUND: Mistakes in the identification and administration of drugs may be fatal. This is especially so in the practice of anaesthesia. This is a report of 2 cases of near fatality due to mistakes in drug administration from look-alike medications.
OBJECTIVE: To highlight the significance of medication errors in our practice and to discuss the best methods of prevention.
METHODS: A report of two cases of errors in the administration of drugs during the conduct of anaesthesia. The subsequent management of the cases is presented, and the findings from the literature are discussed.
RESULTS: In case 1, an adult male presented for herniorrhaphy and after induction with propofol 1mg/kg intravenously, Pancuronium bromide injection 4 mg was administered intravenously, in the place of suxamethonium chloride injection. In case 2, For induction of anaesthesia, 100mg of thiopentone sodium was administered in place of 25mg of the same drug because Thiopentone 1 gm vial was mistaken for Thiopentone 500 mg vial in a 2 year old girl. In both cases, the errors were detected early and there were no adverse sequelae.
CONCLUSIONS: Medication errors are a potential source of iatrogenic harm to patients undergoing anaesthesia. Strict adherence to principles as well as constant vigilance would minimize this problem.

BACKGROUND: Present practice guidelines recommend sedative-analgesic and neuromuscular blocking administration during therapeutic hypothermia in comatose patients after cardiac arrest. However, none suggests the best administration protocol. In this study, we evaluated intensivists\' preferences regarding administration.
METHODS: A systematic literature review was conducted to identify clinical studies published between 1997 and July 2009. Selected articles had to meet the following criteria: use of hypothermia to improve neurologic outcome after cardiac arrest, and specific mention of the sedative protocol used. We checked drugs and dose used, the reason for their administration, and the specific type of neurologic and neuromuscular monitoring used.
RESULTS: We identified 44 studies reporting protocols used in 68 intensive care units (ICUs) from various countries. Midazolam, the sedative used most often, was used in 39 ICUs at doses between 5 mg/h and 0.3 mg/kg/h. Propofol was used in 13 ICUs at doses up to 6 mg/kg/h. Eighteen ICUs (26%) did not report using any analgesic. Fentanyl was the analgesic used the most, in 33 ICUs, at doses between 0.5 and 10 microg/kg/h, followed by morphine in 4 ICUs. Neuromuscular blocking drugs were routinely used to prevent shivering in 54 ICUs and to treat shivering in 8; in 1 ICU, their use was discouraged. Pancuronium was used the most, in 24 ICUs, followed by cisatracurium in 14. Four ICUs used neuromuscular blocking drug administration guided by train-of-four monitoring and 3 ICUs used continuous monitoring of cerebral activity.
CONCLUSIONS: There is great variability in the protocols used for anesthesia and analgesia during therapeutic hypothermia. Very often, the drug and the dose used do not seem the most appropriate. Only 3 ICUs routinely used electroencephalographic monitoring during paralysis. It is necessary to reach a consensus on how to treat this critical care population.

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BACKGROUND: The mortality of severe tetanus (grades II-III) remains high today, being greater than 20% with a large number of complications, due to the lengthy stay of these patients in the ICU.
METHODS: A review of 13 cases of severe tetanus over the last 5 years was performed analyzing age, entrance, previous immunization, ICU stay, grade of severity, complications and mortality.
RESULTS: The ages ranged between 35 to 79 years (mean 54 years). No patient had been previously immunized. Entrance was determined in 11 patients (84.6%). The mean ICU stay was 27.3 days. Complications were presented in 76.8% of the patients, with the most frequent being vegetative alterations (38%). The global mortality was 30.7% (4 patient), 3 secondary to sepsis of pulmonary origin and one from a cardiac arrest of vegetative etiology.
CONCLUSIONS: The authors believe that prophylaxis is fundamental in prevention of the disease but an important sector of the population remains unvaccinated. On appearance of severe tetanus, admission to the ICU is essential since many complications may appear requiring specialized techniques and personnel.

BACKGROUND: The use of nondepolarizing neuromuscular blocking drugs (NDNMBDs) via continuous infusion in the intensive care unit (ICU) is gaining in popularity. Several new NDNMBDs have been developed recently; these drugs vary in their elimination, metabolism, and half-lives.
METHODS: A review of the recent English language literature was done, with those articles relevant to the ICU being incorporated into this paper.
RESULTS: The six most frequently used NDNMBDs, consisting of atracurium, cisatracurium, doxacurlum, pancuronium, rocuronium, and vecuronium, were reviewed. The neuromuscular junction and impulse transmission, clinical monitoring, clinical pharmacology, the elimination and metabolism, the adverse reactions, and the drug interactions of these NDNMBDs are reviewed.
CONCLUSIONS: The use of NDNMBDs is progressively increasing in ICUs. Proper understanding of normal neuromuscular physiology, clinical pharmacology, and drug interactions is essential to optimize patient care and to minimize the risk of adverse reactions.

A review of clinical and experimental data pertaining to drug-induced asthma is presented. Various drugs and drug additives causing asthma are classified and their possible modes of action in inducing asthma are discussed. Practical recommendations for diagnosis and prevention of drug-induced asthma are enumerated.

In vitro (rat hemidiaphragm) and in vivo (rat and cat tibialis anterior muscle preparation) studies of the interactions between Org NC 45 and some i.v. anaesthetics and antibiotics were carried out. With the exception of ketamine 1 mg kg-1 none of the drugs tested in vivo significantly changed the time course of an Org NC 45 bolus injection. All of the drugs caused an enhancement of the neuromuscular block using infusions in vivo and also in the in vitro preparations. Org NC 45 seems to be potentiated in a manner similar to pancuronium.

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The quantitative and qualitative aspects of the phenomenon of resistance to competitive (non-depolarizing) neuromuscular blocking agents in burn patients are described. The correlates and temporal features of this resistance are discussed, in addition to therapeutic approaches and the possible mechanisms underlying the resistance.

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