In this issue:

APSF Hosts Medication Safety Conference

APSF Funds New Registry

Web Application to Track Patient Safety During Sedation

Dear SIRS—Why Do New Defaults Turn Off CO2 and Apnea Alarms?

Q&A—Exposure to Ultraviolet Radiation in the Operating Room

Hospital Coalition Group Endorses APSF Recommendations for PCA Monitoring

Letters to the Editor:

Accidental Intrathecal Injection of Tranexamic Acid in Cesarean Section: A Fatal Medication Error

Non-Opiate Analgesics & CPAP May Prevent Postoperative Respiratory Depression

Chlorhexidine-Alcohol Preparation Solution Contributes to Risk of Combustion

Growing Pains: Unavoidable Collateral Damage or Time for a Warning?

Gas Cylinder Colors ARE NOT an FDA Standard!

Is Hydromorphone PCA Safer Than Morphine PCA?

Syringe Labeling Made Simple

Distractions in the Operating Room: Should the Use of Personal Computers Be Banned during the Administration of Anesthesia?

Letter to the Editor:

Is Hydromorphone PCA Safer Than Morphine PCA?

To the Editor:

Concerning respiratory depression with patient controlled analgesia (PCA),1 there is reason to suspect hydromorphone may be inherently safer. Hydromorphone has a more rapid and complete penetrance to the central nervous system. Hence, peak effect occurs in about 10 minutes. With morphine and its metabolites, you may achieve 70% of its peak effect in 10 minutes, but the peak effect may not occur for up to 90 minutes. Hence, if you titrate to effect with 10 minute lockouts, with morphine, you are setting up for a delayed overdosage, but not with hydromorphone. Has there been a study comparing the safety of hydromorphone (Dilaudid) vs. morphine PCA?

Jonathan Roth, MD
Philadelphia, PA

Reference

  1. Stoelting RK. Dangers of postoperative opioids—Is there a cure? APSF Newsletter 2009:24(2);25-6.