To the Editor
Dr. Lambert clearly presents the need for commercially prepared appropriately diluted resuscitation medications.1 In the absence of such, some of the concerns that he identifies can be addressed by a hospital (or OR satellite) pharmacy.
A pharmacy can prepare batch sealed 10 mL syringes of phenylephrine 80 mcg/mL and ephedrine 5 mg/mL. If kept refrigerated, these syringes are good for 7 days after preparation. Advantages of this system include standardizing the dilution concentration in every location, a reduced risk of infectious contamination, a presumed reduced risk of dilution errors (especially if anesthesia trainees are present), anesthesia provider time saving, and appropriate labeling as required by the JCAHO and Department of Health. There is less wastage of medications and diluent since a pharmacist can produce 25 10mL syringes of 80 mcg/mL phenylephrine from just two 10-mg phenylephrine vials and one 250 mL IV solution bag.
Similarly, a pharmacy can prepare 250 mL bags of vasoactive medications (e.g., phenylephrine 80 mcg/mL, epinephrine 16 mcg/mL, and norepinephrine 16 mcg/mL) that are kept immediately available in a conveniently located refrigerator for major cases (e.g., liver transplants, cardiac surgery, and significant trauma cases). Often there is time urgency in starting these cases; having these drugs already prepared could save critical time. Bolus doses can be withdrawn from these bags.
However, with the recently issued USP Chapter 797 standards, it is more difficult for hospital pharmacies to prepare batch medications. For those hospitals that can, the above benefits can be accrued.
Jonathan V. Roth, MD
- Lambert DH. System fixes needed to prevent drug errors. APSF Newsletter 2005;20:54-5.