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Page 39 M E D S A F E T Y ----------------------------------------- DANGEROUS DOSES Anesthesia's 7 Deadly Drugs The importance of administering the right dose to the right patient at the right time potential killers. ----------- PREFENTIAL TREATMENT Store high-risk medications away from the general drug population. ----------- Epinephrine (1mg/1ml ampoule) is used during sudden cardiac arrest to treat asystole and refractory ventricular fibrillation and anaphylaxis. It can also be used to treat decreased cardiac output. If accidentally injected into a healthy patient, it will immediately cause major hypertension and tachycardia. The drug can be lethal in elderly patients or individuals with diminished cardiac reserve. Phenylephrine (10 mg/1ml ampoule) effectively treats hypotension when injected in 100mcg doses or used as a dilute infusion. When injected in error, it causes major hypertension and reflex bradycardia, and can be lethal in elderly patients or patients with diminished cardiac reserve. Nitroprusside (50mg/2ml) is used to treat hypertension. If it’s injected without first being diluted, the patient will experience rapid arterial vasodilation and severe hypotension. Insulin (100 Units/1ml, 10ml vial) is used to treat hyperglycemia, with typical doses ranging from 5 to 30 units. Overdosing an anesthetized patient will result in severe hypoglycemia and brain death. Potassium chloride (20mEq/10ml) is used to treat hypokalemic patients. If administered erroneously as a bolus, it can cause severe ventricular arrhythmias and death. Heparin (1000U/ml) is an important anticoagulant, used routinely in open heart and vascular surgeries. It can cause unexpected intraoperative bleeding if administered in error. Isoproterenol (1mg/5ml) can be used as a dilute infusion to increase heart rate in critically ill patients. When injected in error, major tachycardia and hypertension will occur. It can be lethal in elderly individuals or in patients with diminished cardiac reserve. — Richard Novak, MD ---------------------------------- injecting medications. Always label syringes when drugs are drawn into them, and be sure to keep workspaces clean and organized. Labeling syringes is not required when placing a spinal or epidural block under sterile conditions and without a break in the process, according to the ASA, which suggests the potential for error is miniscule because the drugs are never out of sight or control of the provider and are administered immediately. Segregated storage In a confidential survey, private practice anesthesia colleagues of mine admitted to mixing up these drugs at some point in their careers: pancuronium 3 9 Richard Novak, MD is heightened when dealing with these SUPPLEMENT TO O U T PAT I E N T S U R G E R Y M A G A Z I N E O N L I N E | O C T O B E R 2013 n