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Canadian Journal of Anesthesia 50:1078 (2003)
© Canadian Anesthesiologists' Society, 2003

Correspondence

REPLY

Jean-Christophe Favier, MD and Laurent Allanic, MD

Metz Armées, France

I agree with Dr. Mahajan that careful labelling of syringes is not sufficient. The use of pre-printed labels with colour codes is an important measure to limit drug confusion. For example, a grey colour code could be used for local anesthetics (Time Med labelling systems®, Burr Ridge, IL, USA). A colour code is a visual alarm to avoid syringe swaps.

I also concur with the recommendation to use 10-mL distinct syringes for neuraxial drug administration. However, the use of these 10-mL specific syringes is uncomfortable for peripheral blocks when 20 to 40 mL volumes are injected. I propose the use of 30-mL Luer-lock syringes for such blocks: 20 to 30 mL injection volumes are common and 30-mL Luer lock syringes are not frequently used for other purposes (in France). Careful incremental injections with repeated aspiration tests are primordial. In our case report,1 20-mL syringes where prepared for postoperative analgesia. The contents of one syringe were injected iv accidentally. If a colour code or a 30-mL syringe had been used, we may, hopefully, not have had to treat the dramatic consequences of this iv injection of 20 mL of 0.375% bupivacaine + 15 µg clonidine.

Reference

1 Favier JC, Da Conceiçao M, Fassassi M, Allanic L, Steiner T, Pitti R. Successful resuscitation of serious bupivacaine intoxication in a patient with pre-existing heart failure. Can J Anesth 2003; 50: 62–6.[Abstract/Free Full Text]


Related articles in CJA:

Avoiding the accidental iv injection of local anesthetics
Rajesh Mahajan
CJA 2003 50: 1077-1078. [Full Text]  




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