ICU Pharmacists e-Group
UKCPA-Critical Care
Hosted by www.ukcpa.org
Critical Care Journal Club Bulletin
August 2015
Selected Bottom Lines:
A System for Anesthesia Drug Administration Using Barcode Technology: The
Codonics Safe Label System and Smart Anesthesia Manager™
Jelacic, Srdjan MD*; Bowdle, Andrew MD, PhD*; Nair, Bala G. PhD† et al.
Anesthesia & Analgesia Issue: Volume 121(2), August 2015, p 410–421
The use of coffee loyalty cards improved compliance with bar code scanning from
25% to 58%
Collated By Patricia Ging
No stars = Paper highlighted for general interest (read only if of particular interest or relevance to you)
One star = Highlighted paper of particular note with relevance to most ICU pharmacists (should be read)
Two stars = Ground breaking or keynote paper of direct relevance to all (essential reading for all ICU pharmacists)
Contributions
The Annals of Pharmacotherapy contributed by Chris Jay, Hutt Valley Hospital
Nil of note from the Annals this month
Chest contributed by Snehal Shah ,RBHT
Nil of note from Chest this month
Anaesthesia and analgesia – Contributed by John Warburton – Bristol Royal Infirmary
Preoperative Aspirin Use and Lung Injury After Aortic Valve Replacement Surgery: A Retrospective Cohort
Study
Mazzeffi, Michael MD, MPH; Kassa, Woderyelesh BA; Gammie, James MD et al. Anesthesia & Analgesia.
Volume 121(2), August 2015, p 271–277
a retrospective single-center cohort study that included all adult patients who had aortic valve replacement
surgery during a 5-year period. The primary outcome variable was postoperative ARDS. There were 22 cases
of ARDS in the cohort (5.5%). preoperative aspirin use was not associated with a decreased incidence of ARDS
after aortic valve replacement surgery
Involvement of Opioid Receptors in the Lipid Rescue of Bupivacaine-Induced Cardiotoxicity
Partownavid, Parisa MD; Sharma, Salil PhD; Li, Jignyuan MD, PhD et al. Anesthesia & Analgesia Volume
121(2), August 2015, p 340–347
Exploratory study in rats to determine the mechanism of action for lipid emulsion in bupivacaine induced
cardiotoxicity. Results suggest that both peripheral [delta] and [kappa] opioid receptors are involved with the
rescue action of lipid emulsions.
Reversal of Pipecuronium-Induced Moderate Neuromuscular Block with Sugammadex in the Presence of a
Sevoflurane Anesthetic: A Randomized Trial
Tassonyi, Edömér MD, PhD, DSc*; Pongrácz, Adrienn MD*; Nemes, Réka MD* et al. Anesthesia & Analgesia.
Volume 121(2), August 2015, p 373–380
Sugammadex adequately and rapidly reverses pipecuronium-induced moderate NMB during sevoflurane
anesthesia. Once the train-of-four count has spontaneously returned to 2 responses following pipecuronium
administration, a dose of 2.0 mg/kg of sugammadex is sufficient to reverse the NMB.
A System for Anesthesia Drug Administration Using Barcode Technology: The Codonics Safe Label System
and Smart Anesthesia Manager™
Jelacic, Srdjan MD*; Bowdle, Andrew MD, PhD*; Nair, Bala G. PhD† et al. Anesthesia & Analgesia Issue: Volume
121(2), August 2015, p 410–421
Many anesthetic drug errors result from vial or syringe swaps. Scanning the barcodes on vials before drug
preparation, creating syringe labels that include barcodes, and scanning the syringe label barcodes before
drug administration may help to prevent errors. In an observational study of compliance following
introduction of a barcode scanning and safe labelling system there was a moderate rate of scanning syringe
label barcodes at the time of drug administration (25%). The authors improved this to 58% with the
introduction of a coffee loyalty card rewarding its use! Further, adaptation of the system will be required to
achieve a higher utilization rate.
To Pretreat or Not to Pretreat: Prophylactic Anticholinergic Administration Before Dexmedetomidine in
Pediatric Imaging
Subramanyam, Rajeev MBBS, DNB, MNAMS, MD, MS*; Cudilo, Elizabeth Maria MD*; Hossain, Mohamed Monir
PhD† et al. Anesthesia & Analgesia. Volume 121(2), August 2015, p 479–485
Dexmedetomidine (Dex) appears to be very effective as a sole sedative for pediatric imaging when used at
high doses, but at an increased risk of transient hypertension, hypotension, and bradycardia. In this
retrospective descriptive study administration of a prophylactic anticholinergic with Dex shows no advantage
other than a transient clinically insignificant increase in HR and SBP, and it may precipitate transient
exaggerated SBP in more patients compared with not using a prophylactic anticholinergic.
Survey of the National Drug Shortage Effect on Anesthesia and Patient Safety: A Patient Perspective
Hsia, Ivan Kai-Hsiang MD*; Dexter, Franklin MD, PhD†; Logvinov, Ilana RN, MSN, CCRP‡ et al. Anesthesia &
Analgesia. Volume 121(2), August 2015, p 502–506
There are few data on patients’ desire to be informed of drug shortages before elective surgery. We surveyed
patients who had previously undergone laparoscopic cholecystectomy for their opinions. Over 50% of 256
respondants (out of 949) wanted to be informed about drug shortages that might affect their care.
Clinical Nutrition contributed by Emma Graham-Clarke, Sandwell and West Birmingham Hospitals NHS Trust
Nil of note this month
Critical Care tweeted directly by Annie Bell Nelson Hospital, NZ
Journal of the Intensive Care Society contributed by Sanchia Pickering, CMFT Manchester 21/08/15
The weight debate
JJ MacDonald, J Moore, V Davey, S Pickering and T Dunne
2015; 16: 234-238, first published on January 8, 2015 doi:10.1177/1751143714565059
The article reviews the size descriptors that have been described to predict patient body size, their origin and
calculation. The article then goes on to examine the role they play in dosing of common therapies utilised in
Critical Care and potential areas of research for the future.
Antibiotic administration in ITU: Are we throwing away that which we hold so dear?
Jack Hodd, Paul Dean, Jennifer Oakley and Justin Roberts
2015;16: 269,doi:10.1177/1751143715577731
Raising issues regarding local practice around the devices used for the administration of antibiotics and the
flushing of the giving set afterwards.
N-acetylcysteine infusion in preventing hepatotoxicity secondary to intravenous injection of household
bleach
Anthony H Eidan, James Sira, and Mark Bellamy
2015;16: 265-268, first published on March 18, 2015 doi:10.1177/1751143715576287
Case presentation following the clinical course and management of a patient who had non-accidentally
injected domestic bleach through a CVC.
A case of overdose via tattoo
Roberta Borg and Antony Ashton
2015;16: 253-256, first published on February 23, 2015 doi:10.1177/1751143715574509
Case presentation of a patient who presented with a fentanyl overdose following the placement of a
transdermal patch placed over a five-day old tattoo.
New England Journal of Medicine contributed by Patricia Ging, Mater Misericordiae University Hospital
Dublin
Disorders of Fluids and Electrolytes Julie R. Ingelfinger, M.D., Editor Electrolyte and Acid–Base Disturbances
in Patients with Diabetes Mellitus
Palmer BF , Clegg DJ .
N Engl J Med 2015;373:548-59
This is particularly strong in explanation of hyponatraemia in hyperglycaemia. Gives an explanation of how to
adjust an apparent hyponatraemia in hyperglycaemia. Not a light read.
Perioperative Bridging Anticoagulation in Patients with Atrial Fibrillation
Douketis JD, et al for the BRIDGE Investigators*
N Engl J Med 2015;373:823-33.
Low risk surgical patients with AF usually on warfarin were randomised to either full anticoagulation with
dalteparin or placebo. Placebo was non-inferior for cloting and better for bleeds. Warfarin was restarted
within 12-18 hours of surgery.
Idarucizumab for Dabigatran Reversal
Glund S, et al
N Engl J Med 2015;373:511-20.
Idarucizumab completely reversed the anticoagulant effect of dabigatran within minutes. (Funded by
Boehringer Ingelheim
Placebo Effects in Medicine
Kaptchuk TJ , Miller FG, Ph.
N Engl J Med 2015;373;1-2
In trials of anticonvulsants for migraine, patients receiving place- bos report memory problems and anorexia,
whereas in trials of trip- tans for migraine, patients receiving placebos report different side effects. This is
called the nocebo effect.
An Integrated View of Potassium Homeostasis
Gumz ML et al
TheN Engl J Med 2015;373:60-72.
For nerd value only, nothing that would assist in management of the patient. A few names of rarer potassium
wasting conditions mentioned.
Permissive Underfeeding or Standard Enteral Feeding in Critically Ill Adults
Arabi YM, et al for the PermiT Trial Group*
N Engl J Med 2015;372:2398-408.
Underfeeding was not beneficial!
List of Contributors
Contributor
Claudia Brocke
University Hospital Southampton NHS FT
Claudia.brocke@uhs.nhs.uk
Journal
Critical Care
Medicine
Contributor
Annie Bell
Nelson Hospital, NZ
Matt Elliott
Royal Derby Hospital
matthew.elliott1@nhs.net
Intensive Care
Medicine
Gillian Mulherron
Newcastle Upon Tyne Hospitals NHS
Foundation Trust
Gillian.Mulherron@nuth.nhs.uk
American Journal of
Respiratory and
Critical Care (First
Fortnight)
Olivia Moswela
Radcliffe Infirmary
olivia.moswela@orh.nhs.uk
Journal
Critical Care
Annie.bell@me.com
New contributor to be confirmed
British Journal of
Anaesthesia
American Journal of
Respiratory and
Critical Care (Second
Fortnight) and
Neurosciences
journals
New England Journal
of Medicine
John Dade
St. James's University Hospital
john.dade@leedsth.nhs.uk
Thorax
Andreas Fischer
Royal Brompton & Harefield NHS Trust
A.Fischer@rbht.nhs.uk
Snehal Shah
Royal Brompton & Harefield NHS Trust
S.Shah6@rbht.nhs.uk
Chest
Circulation
Alan Timmins
Queen Margaret Hospital
alan.timmins@nhs.net
Anaesthesia
Anja Richter
Whittington Health
anja.richter@nhs.net
Lancet (Weekly)
John Warburton
Bristol Royal Infirmary
University Hospitals Bristol NHS
Foundation Trust
John.Warburton@UHBristol.nhs.uk
Anaesthesia and
Analgesia
Jane Sheldon
Stockport
Jane.Sheldon@stockport.nhs.uk
JAMA (weekly)
Chris Jay
Hutt Valley Hospital, NZ
chris.jay@huttvalleydhb.org.nz
The Annals of
Pharmacotherapy
New contributor to be confirmed
BMJ (Weekly)
New contributor to be confirmed
Emma Graham-Clarke
Sandwell and West Birmingham Hospitals
NHS Trust
emma.graham-clarke@nhs.net
Key articles from
clinical nutrition and
e-SPEN
Sanchia Pickering
CMFT, Manchester
Sanchia.Pickering@cmft.nhs.uk
Anaesthesia and
Intensive Care
medicine
Journal of the
Intensive Care
Society
Patricia Ging
Mater Misericordiae University Hospial
Dublin
pging@mater.ie
New contributor to be confirmed
(List last updated 2 August 2015)
Next Bulletin scheduled to
[Louise.Dunsmure@ouh.nhs.uk]
go
out:
September
2015
Collator
will
be
Louise
Dunsmure