[Precision of drug dilution techniques]. / Precisione dei metodi di diluizione dei farmaci.

OBJECT: Evaluation of accuracy of three common dilution methods for drugs. EXPERIMENTAL PLAN: Perspective double blind investigation from March to June 1995. PLACE: Anaesthesia and Resuscitation Service of Children's Hospital of Iglesias (CA). METHODS: Forty dopamine at 2/1000 samples, obtained by dilution of dopamine at 40/1000 on sale with three different methods by five different operators, were analysed with a chromatography system in liquid phase at high pressure. RESULTS: Mean concentration with difference not exceeding 5% from the goal, are considered acceptable. Only one group of samples was found to be into these limits, but it was also the most dangerous for the high percentage of great mistakes in dilution. Although there are significant differences in the accuracy and safety of the three dilution methods, the highest and lowest final concentrations obtained differ very much from those estimated. CONCLUSIONS: It is suggested that drugs confections with proper dilution for different clinical uses might be on sale.

[An anesthetized anesthesiologist tells his experience of waking up accidentally during the operation]. / Un anestesista anestetizzato racconta la sua esperienza di risveglio accidentale intraoperatorio.

We report the recollections of an anaesthesiologist who experienced urogenital surgery under balanced anaesthesia which was insufficient to prevent awareness during a part of the procedure. The patient was hard apprehensive before surgery and neither sedative nor amnesic drugs were done as premedication. He received an Innovar, thiopentone, suxamethonium, nitrous oxide/oxygen sequence for intubation. Awareness occurred not long after but before administration of isoflurane for maintenance. In that terrifying moments the patient was conscious without pain. According to him the worst aspect of the experience was desperately wanting to move or speak and being unable to do so. In the event of unexpected awareness, the anaesthesiologist must deal with the patient in an honest and forthright manner. Failure to do so lead to dire psychological consequences for the patient and expensive malpractice litigation for the anaesthesiologist.