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Digital Issues

Ondansetron May Trigger Arrhythmias, FDA Warns

The anti-nausea, anti-emetic drug ondansetron may trigger dangerous, even deadly, arrhythmias in patients who have pre-existing heart conditions, according to an FDA warning issued last week.

The agency's Sept. 15 warning noted that ondansetron (Zofran) may increase the risk of "developing prolongation of the QT interval of the electrocardiogram, which can lead to an abnormal and potentially fatal heart rhythm, including Torsade de Pointes."

Patients at the greatest risk include those with "underlying heart conditions such as congenital long QT syndrome, [and] those who are predisposed to low levels of potassium and magnesium in the blood" as well as patients taking other medications also associated with QT prolongation.

The FDA has ordered GlaxoSmithKline, which markets Zofran, to conduct a thorough study to determine the severity of these potential aberrations and report its findings by summer 2012.

In the meantime, the FDA has ordered that the drug's label be changed to include a warning to avoid its use or accompany its use with ECG monitoring among at-risk patients.

Mark McGraw

Nurse Accused of Stealing Pain Meds Gets Probation

The nurse who reportedly told her patient to "man up and take some pain" after allegedly stealing a portion of his intended fentanyl dose has copped a plea that will keep her out of jail.

Sarah Casareto, RN, received 3 years' probation as part of the plea agreement. The alleged theft occurred while she was tending to patient Larry King, 56, who was on his way to the OR for kidney stone surgery at Abbott Northwestern Hospital in Minneapolis, Minn.

"Clearly I remember (the "man up" comment)," Mr. King told local reporters. "I can't really use the language I'd use to describe what it's like when you lay on that table and can hear and feel everything they're doing to you."

OR personnel reportedly had to hold down the screaming and moaning Mr. King during the procedure. Ms. Casareto, who was said to appear drugged, told him to "Go to your beach. Go to your happy place."

Ms. Casareto's attorney says he was prepared to call witnesses who would have denied that Mr. King was in excessive pain during the procedure. But he refused to comment further, citing Ms. Casareto's pending review before the state nursing board, where she will attempt to regain her license.

Tony Nemo, Mr. King's attorney, says he "vigorously" opposed the plea deal and is pursuing civil lawsuits against Ms. Casareto and the hospital that formerly employed her.

"Due to confidentiality we cannot discuss current or former employees," said Abbot Northwestern in a statement issued at the time of Ms. Casareto's arrest in February. "She no longer works (at the hospital). Patient safety is our primary concern."

Daniel Cook

OR Excellence Hotel Discounts Extended

The specially discounted rate of $199 a night at the Manchester Grand Hyatt San Diego, site of this year's OR Excellence conference, has been extended through Wednesday, Sept. 21. The surgical conference of the year is almost here, and we've taken the worry out of securing the best lodging for the event, scheduled for Oct. 5-7.

The Manchester Grand Hyatt will be the center of all conference activities, and features the lowest cost of any 4-star-plus hotel in the area. Take a look at how our discounted rates compare to those of surrounding hotels:



Stay in comfort and style while learning how to improve your surgical outcomes, expand your caseload, grow more profitable, protect your employees and assets and more. The Manchester Grand Hyatt boasts a spectacular waterfront location and lavish amenities.

You can take in stunning views from its inviting pool area, play tennis or be pampered in the serene Kin Spa. The resort is ideally placed to let you explore all that San Diego has to offer. Step outside to Seaport Village and cruises on the Bay, walk to the Gaslamp Quarter, visit the San Diego Zoo and SeaWorld, then browse museums in Balboa Park. Discover the advantages of this downtown San Diego hotel, distinctively heralded as among the city's best.

But hurry: The $199-a-night rate expires Wednesday, Sept. 21, so act now. For more details and to register, visit ORExcellence.com or call (888) YOUR-ORX.

Stephen Archibald

InstaPoll: OR Border Control

Sales reps. Students. Repairmen. And who are those 2 people in the corner? Yes, the OR can be a crowded place if you don't restrict who's allowed in. What is your greatest concern for controlling access to your ORs? Tell us in this week's InstaPoll.

The road to going paperless is a slow one. Only about 1 in 3 of those who took last week's poll have converted to EMRs. Most respondents (57%) have it on their to-do lists. Here are the results from 97 responses when we asked whether you've converted to electronic medical records yet:

  • Yes, and we're happy with the results: 24%

  • Yes, but we miss our paper charts: 8%

  • Not yet, but we're planning to do so: 57%

  • We don't plan to go electronic: 11%

    Dan O'Connor

  • October 14th E-WEEKLY

    News & Notes

  • Hospital investigating privacy breach Stanford Hospital has confirmed that a medical privacy breach led to data for 20,000 emergency room patients being posted on a commercial website. Since discovering the breach in August, the Palo Alto, Calif.-based hospital has been investigating how a spreadsheet including names, diagnosis codes, admission and discharge dates, account numbers and billing charges for patients appeared and stayed online for nearly one year. The affected patients were seen at Stanford Hospital's ER during a six-month period in 2009.

  • Does anesthesia delay brain development? General anesthesia impairs neuronal activity and communication in the developing brains of animals, which could result in long-lasting cognitive impairment, according to research published in the August issue of Current Opinion in Anesthesiology. The study's author, Vesna Jevtovic-Todorovic, MD, PhD, MBA, professor of anesthesiology and neuroscience at the University of Virginia Health System and scientific advisory board member of SmartTots (a partnership between the FDA and the International Anesthesia Research Society aimed at mitigating anesthesia-related neurotoxicity in children) says it's important to determine when synaptogenesis begins and ends in developing humans and develop techniques that use current anesthetics with minimal neurotoxic side effects.

  • Tip of the week How prepared is your staff for an emergency if every drill is a pre-planned walkthrough? Put them to the test with a surprise (but pretend) fire, writes Nancy Burden, RN. She suggests reviewing emergency procedures with your staff, but keeping them in the dark as to when they'll discover a fake fire that they'll have to handle as if it were a real and sudden crisis.
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