The preparation and storage of anaesthetic drugs for obstetric emergencies: a survey of UK practice

Background: Traditionally anaesthetic drugs for obstetrics are prepared as a contingency and stored until they are required for emergency use or have expired. Expiry is based on presumed reduction in sterility and efficacy although evidence for this is inconsistent. Preparation in advance introduces the risk of error and potential for tampering by a third party. Discarding and re-preparing drugs daily represents significant wastage with associated cost implications. We predicted that practice of drug preparation would differ widely across the UK, so conducted a national survey. Method: A postal questionnaire was sent to lead consultant obstetric anaesthetists at each of the 223 consultant-led UK obstetric units enquiring about the preparation of anaesthetic drugs for obstetric emergencies. Results: The response rate was 75%; 87% of units routinely draw up emergency drugs, most commonly thiopental and succinylcholine. Only 10% routinely use commercially-prepared succinylcholine syringes, although a further 8% would use them if available. Thiopental is prepared by anaesthetists in 78% of units, operating department practitioners in 8% and pharmacy in <7% of cases. Drugs are changed every 24 h in 80% of units and weekly in 6%. With one exception, all units changing drugs weekly use pharmacy-prepared thiopental. Conclusion: The majority of UK obstetric units routinely draw up emergency drugs every 24 h. With conflicting evidence regarding sterility and efficacy this represents tremendous wastage and potential for drug error and tampering. We propose that nationwide introduction of commercially- and pharmacy-prepared drugs with long shelf lives would improve safety and cost effectiveness. (C) 2009 Elsevier Ltd. All rights reserved.