Quality control and stability of ketamine, remifentanil and sufentanil syringes in a pediatric operating theater

Abstract

Background

Transforming a drug from its commercial form into a ready‐to‐use drug is common practice, especially in pediatrics. However, the risk of compounding error is real and data on drug stability in practise are not always available.

Aims

To assess, in real conditions, both the error rate and stability of 3 drugs: ketamine, remifentanil and sufentanil.

Methods

A new rapid and easy‐to‐use high‐performance liquid chromatography method with a diode array detector has been developed and validated to quantify these drugs and detect their degradation products. Over a one‐month period 151 syringes were collected in the post‐anesthesia care unit. 73 were stock solution syringes containing a 10‐fold dilution of commercial drugs and 78 were serial dilution syringes made from successive dilutions of stock solutions. A comparison between real and expected concentrations as well as the detection of possible degradation products was carried out on these samples.

Results

All stock solution syringes had good chemical stability throughout the working day. A 4‐μg/mL remifentanil serial dilution syringe however had to be discarded as a degradation peak was detected. Overall, 15.3% (95%CI, 9.5–21.1%) of syringes had a drug concentration outside the ±10% acceptability range, i.e. 11.0% (95%CI, 3.7–18.2%) and 19.5% (95%CI, 10.6–28.4%) of stock and diluted syringes respectively, with drug amounts ranging from ‐25.3% to 22.0%. The highest error rates were observed with sufentanil syringes: 20% and 28% for stock solution and serial dilution, respectively.

Conclusion

The study shows that stock solution syringes prepared in advance are chemically stable throughout the day, unlike certain serial dilution syringes, indicating that the latter should be prepared just before administration to ensure chemical stability. Our results show that the error rate for serial dilution syringes is twice that of stock solution. Different safety measures are under discussion and have to be further studied.

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Use of Opioid Analgesics in Patients with Chronic Low Back Pain and Knee Osteoarthritis

No abstract available

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Fit4SurgeryTV at-home prehabilitation for frail elderly planned for colorectal cancer surgery: a pilot study

Objective The preoperative phase is a potential window of opportunity. Although frail elderly patients are known to be more prone to postoperative complications, they are often not considered capable of accomplishing a full prehabilitation program. The aim of this study was to assess the feasibility of Fit4SurgeryTV, an at-home prehabilitation program specifically designed for frail elderly with colorectal cancer (CRC). Design The Fit4SurgeryTV program consisted of a daily elderly-adapted computer-supported strength training workout and two protein-rich meals. Frail patients ≥70 years with CRC were included. The program was considered feasible if 80% of the patients would be able to complete 70% of the program. Results Fourteen patients (median age 79, 5 males) participated. At baseline, 86% patients were physically impaired and 64% were at risk for malnourishment. Median duration of the program was 26 days. The program was feasible as patients followed the exercises for 6/7 (86%) days and prepared the recipes 5/7 (71%) days per week. Patients specifically appreciated at-home exercises. Conclusion This study showed that at-home prehabilitation in frail elderly with CRC is feasible. As a result, patients might be fitter for surgery and might recover faster. The perioperative period could serve as a pivotal time point in reverting complications of immobility. Address for correspondence and requests for reprints: Emma RJ Bruns, MD, Department of surgery, Academic Medical Centre, PO Box 22660, 1100 DD Amsterdam, The Netherlands, Tel: +31-6-14041036. E-mail: e.r.bruns@amc.nl During review process: e.r.bruns@amc.nl Category: Pilot study Conflicts of interest and source of funding: None Based on a previous communication to a society or meeting: Abstract presentation at the 2nd World Prehabilitation Congress in Eindhoven, The Netherlands, on June 29th 2018. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Rehabilitation – key for healthy ageing and longevity

No abstract available

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Empowering Physiatrists In-Training to the Peer-Review Process

No abstract available

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Injury of the Medial Lemniscus due to Compression of the Medulla Oblongata by Tortuous Vertebral Artery

No abstract available

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Activation of Supraspinatus and Infraspinatus Partitions and Periscapular Musculature during Rehabilitative Elastic Resistance Exercises

Objective The purpose of this study was to quantify the activation of partitions within supraspinatus and infraspinatus and some periscapular muscles during four resistance exercises with elastic bands. Design 27 right handed healthy volunteers (22.5 ± 2.7 years old) were recruited. Intramuscular EMG from supraspinatus (anterior and posterior) and infraspinatus (superior and middle) and surface EMG data from the upper, middle and lower trapezius and serratus anterior were recorded during four elastic resistance exercises (Y, T, W, L). Kinematics were recorded synchronously. Electromyography values were presented as % of maximal voluntary isometric contraction (MVIC) and compared across exercises using ANOVA. Muscle activation ratios were also calculated. Results Mean activations of all rotator cuff partitions were over 40% MVIC, except middle infraspinatus during the T exercise (29.3% MVIC). Serratus anterior activity was significantly higher during the Y exercise (p

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