To the Editor
The APSF Newsletter is always very informative and it is a pleasure to read it. It is a great source of practical details and it conveys a lot of safety rules that helps us all; patients and physicians alike.
In the Fall 1990 issue, Dr. Mark P. Fritz answered on the problem of contamination while handling local anesthetic ampoules. We would like to contribute with our experience to the subject.
In a “Letter to the Editor” addressed to the revista Brasileira de Anestesiologia (1) we stressed the need of autoclaving all local anesthetic agents, specially the ones to be used for spinal and epidural analgesia.
In Brazil them have been two reports of deaths after spinal analgesia due to meningitis. (1,2,3) In both instances, the fact that the ampoules were not sterilized on the outside was blamed as the cause of the infection.
One of these misfortunes happened at the hospital we were working in 1957.(2) Since then, we have instituted the routine autoclaving of all drugs used for central nerve blocks. No infections were seen after the adoption of this procedure.
We did not observe any physical change or lack of potency in the agents so treated, even when we were dealing with procaine or pontocaine. Of cease, with bupivacaine and lidocaine heat is no problem. Ten percent solutions of glucose and 1: 1000 ampoules of epinephrine have also been prepared in the same way, without any difficulties.
The autoclave is kept at 121 degrees C and under two atm pressure for 15 minutes. The ampoules are sterilized inside clear glass test tubes, marked with the date and the name of the person in charge. It is closed by sensitive tape, to confirm that the sterilization operation was done correctly. The tubes are kept up to one month. If they are not opened within this time, the process is repeated once month.
After 32 years’ experience, we are convinced that this system should be mandatory for all ampoules intended to be applied for spinal or epidural analgesia. Without any doubt this will increase the patient’s safety.
As a fringe benefit, this procedure will abolish or decrease almost to zero the chances of one injecting the wrong drug when doing a spinal or an epidural block. In Brazil, in places where this procedure is not utilized, there have been reports of over ten cases of spinal blocks where gallamine, dipyrone, cedilanid or pancuronium were administered by mistake into the subarachnoid space with fatal or dire results.’,’
We hope that this observation can be of value to our colleagues.
Professor Armando Fortuna, M.D.
Director, Department of Anesthesia, Post Graduate Training Center, “Centro Integrado de Santos”
Anibal de O. Fortuna, M.D.
Instructor at the Post Graduate Training Center Brazil
- Fortuna A; Esterilizacao de Ampolas para Anestesias Espinhais, Cartas ao Editor. Rev Bras Anesth 39:241, 1989
- Fortuna A; Bloqueios Anestesicos: Rev Bras Anesth 13:227-262, 1963
- Vieira ZEG: Complicacoes da anestesia raquidea. Relato de um caso de meningite pos-raquianestesia (Miscelanea); Rev Bras Anesth 12:77, 1962