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Can Items on an Aviation-Style Checklist for Preparation of Cesarean Delivery Under General Anesthesia Present a Threat for Patient Safety?

Schwarz, Stephan K. W. MD, PhD, FRCPC

doi: 10.1213/01.ANE.0000190875.15804.14
Letters to the Editor: Letters & Announcements

Department of Anesthesiology, Pharmacology and Therapeutics, Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada,

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To the Editor:

I read with great interest the article by Hart and Owen (1) and commend the authors for their initiative to improve the safety of patients undergoing cesarean delivery under general anesthesia through introduction of an aviation-style checklist. However, I question whether inclusion in the checklist of the two items “Oxytocin” and “Nondepolarizing muscle relaxant” under the heading “Drugs drawn up” may present a potential risk, rather than improvement, for patient safety. Drug errors are among the most common threats to patient safety in anesthesiology (2,3), often involving muscle relaxants (3) as well as oxytocin in obstetric anesthesia (4). Neither oxytocin nor nondepolarizing muscle relaxants are mandatory components of the induction of anesthesia for cesarean section, and inadvertent administration of either drug may yield catastrophic outcomes. In a recent systematic review of strategies to minimize anesthetic drug errors, “removal of dangerous drugs from the operating theaters” was identified as one of four classified “strongly recommended” (5). On the basis of these findings, the items “Oxytocin” and “Nondepolarizing muscle relaxant” may perhaps be more safely included in a checklist under a separate heading such as “Drugs readily available.”

Stephan K. W. Schwarz, MD, PhD, FRCPC

Department of Anesthesiology, Pharmacology and Therapeutics

Faculty of Medicine

The University of British Columbia

Vancouver, BC, Canada

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1. Hart EM, Owen H. Errors and omissions in anesthesia: a pilot study using a pilot's checklist. Anesth Analg 2005;101:246–50.
2. Smith J. Building a safer NHS for patients: improving medication safety. London: NHS Department of Health, 2004. Available at:, accessed 7/27/2005.
3. Orser BA, Chen RJ, Yee DA. Medication errors in anesthetic practice: a survey of 687 practitioners. Can J Anaesth 2001;48:139–46.
4. Yentis SM, Randall K. Drug errors in obstetric anaesthesia: a national survey. Int J Obstet Anesth 2003;12:246–9.
5. Jensen LS, Merry AF, Webster CS, et al. Evidence-based strategies for preventing drug administration errors during anaesthesia. Anaesthesia 2004;59:493–504.
© 2006 International Anesthesia Research Society