The following abstract is by Dr Anita Holdcroft from her presentation at the APRIL conference on 6 November 2008.
Abstract
Anaesthetic adverse events – can they be prevented?
Dr Anita Holdcroft
Since the last APRIL conference in 2004, there have been significant developments in identifying anaesthetic drug reactions as well as on line availability of information on adverse events. For example, the Royal College of Anaesthetists (www.rcoa.ac.uk) has developed a series of patient information files of which the one on confusion after surgery sets out its frequency, the causes such an event and how patients can avoid it.
http://www.rcoa.ac.uk/docs/Risk_7confusion.pdf
Since 2005, the Medicines and Healthcare products Regulatory Agency (MHRA) has allowed patients to report on so-called ‘Yellow Forms’ to add to the data collected and summarized in Drug Analysis Prints http://www.mhra.gov.uk
The MHRA have furthermore made available to our research team additional data from which we were able to produce more detailed analyses of hazard signals for pain relieving drugs used during anaesthesia [1]. Two analgesic drugs, fentanyl and nalbuphine, had particular hazards for psychiatric reports. Since there are many limitations in reporting data collected on the yellow forms these hazard signals need verification by further research. One limitation is in the identification of the causal agent because of the quantity of drugs given during anaesthesia, including prophylactic antibiotics.
Interestingly only this week, recurrent acute psychosis with confusion, agitation, hallucinations, delusions and disordered speech caused by such antibacterial agents was reported with full recovery of the patient (BMJ 2008;337:996). Another patient may not have such a good outcome and in yet another, this type of event may have been prevented through a detailed medical history. The MHRA reports suggest that similar symptoms occur in relation to many of the anaesthetic drugs used daily. Hence it is proposed that there may be recurrent and/or delayed onset of effects which up to the present have not been sufficiently recognised or reported.
References from the presentation
1. Richardson J, Holdcroft A. Results of forty years Yellow Card reporting for commonly used peri-operative analgesic drugs. Pharmacoepidemiology and Drug Safety 2007;16:687-694.
2. Richardson J, Holdcroft A, Results of forty years yellow card reporting for commonly used peri-operative analgesic drugs. Br J Anaesth 2006;96:276P
3. Holdcroft A. UK Data Analysis Prints and Anaesthetic Adverse Drug Reactions. Pharmacoepidemiology and Drug Safety, 2007;16:316-328
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