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Package Inserts Are a Must Read for Anesthesiologists

Sosis, Mitchel B. M.S., M.D., Ph.D.

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To the Editor:—

I read with interest the recent report and accompanying editorial regarding package inserts or the label for medications.1,2 This important subject has previously received little attention in the anesthesiology literature.
Anesthesiologists are in an envious position relative to many other medical specialties because they regularly use only a limited number of medications. This makes it all the easier to be familiar with the package inserts for these drugs. The inserts are free and convenient. They contain a wealth of information such as indications, contraindications, side effects, and drug interactions.
Physicians should be aware of the indications for drugs and realize that they can be criticized for using them in off-label applications if problems arise. A case in point is the intrathecal use of fentanyl.1 Indeed, armed with the knowledge that this common application is not indicated, clinicians could push for appropriate testing for its approval.
Those medications carrying boxed warnings, the most stringent type, deserve special attention. Some examples are succinylcholine, droperidol, midazolam, and ketorolac.
Mitchel B. Sosis, M.S., M.D., Ph.D.
Holy Redeemer Hospital and Medical Center, Meadowbrook, Pennsylvania.
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1. Chang NS, Simone AF, Schultheis LW: From the FDA: What’s in a label? A guide for the anesthesia practitioner. Anesthesiology 2005; 103:179–85

2. Roizen MF: What’s wrong with this label? Anesthesiology 2005; 103:4–5

© 2006 American Society of Anesthesiologists, Inc.

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