The most common regional anesthesia errors include mixed-up ampoules or syringes and epidurals mistaken for IV lines, according to a literature review presented at the 2012 annual meeting of the International Anesthesia Research Society.

Sanosh Patel, MD, an anesthesiologist at Pennine Acute NHS Trust Hospital in Oldham, England, reviewed 34 published cases of regional anesthesia errors and found that, in some cases, patients received potentially life-threatening epidural injections of neuromuscular blocking agents and blood-clotting medications.

Dr. Patel offered strategies for averting these kinds of errors: using ampoules of various sizes, shapes and surface textures, so the anesthesiologist will be able to recognize different drugs by touch; applying different-colored labels to drugs and infusion bags; separating drug trays; bar-coding pre-filled syringes; and using different connectors to delineate epidural and IV injections.

Stephanie Wasek

Hyponatremic patients with low sodium levels are at an increased risk of complications and death within a month of surgery, according to a study published online in the Archives of Internal Medicine.

Of the nearly 1 million adult patients who underwent major surgery between 2005 and 2010, reviewed by researchers at Brigham and Women's Hospital in Boston, almost 8% presented for surgery with hyponatremia, an electrolyte disorder marked by low serum sodium levels. Patients with the condition were more likely to suffer major coronary complications, surgical site infections, pneumonia and prolonged hospital stays, and were also 44% more likely to die at 30 days post-op, according to the study.

The study's authors concede further research is needed to determine whether correcting pre-operative hyponatremia will mitigate associated risks, especially because of "legitimate concern" about interventions that significantly and rapidly alter sodium levels over a short time.

In an accompanying commentary, Joseph Vassalotti, MD, associate clinical professor of medicine and nephrology, and Erin DuPree, MD, assistant professor of obstetrics, gynecology and reproductive science at Mount Sinai Medical Center in New York City, note nearly 80% of patients involved in the study underwent pre-op serum sodium testing and wonder if the screening should be routine prior to all surgeries.

"The pre-op evaluation should strive to determine whether the patient is in optimal health and whether the individual's condition could be improved before surgery," they say. "Previous hyponatremia and conditions commonly associated with hyponatremia are reasonable indications to perform serum sodium assessment."

Daniel Cook

You might not be able to see them, but microscopic particles of blood and tissue, anesthesia gas vapors, latex-laden powder and other potentially harmful, aerosolized by-products of surgery are swirling around your ORs. The impact they have on your patients' outcomes, not to mention your staff's health, depends on what action you've taken to control and remove them.

"Never assume that just because you've got a ventilation and filtration system in place, it must be working," says one clinical environmental expert. Good OR air quality takes a combination of engineering controls and best practices, along with the routine maintenance and consistent compliance that keeps them both effective.

Check out this advice on clearing contaminants from your surgical suite and breathe easier.

David Bernard

The U.S. presidential election is not for another 7 weeks, but we wanted to get a sense of which way the ambulatory surgery industry is leaning. If the election were held today, who would you for vote for — Barack Obama or Mitt Romney? Cast your vote in Outpatient Surgery Magazine's straw poll.

What's the most stressful part of your job?
What stresses surgical facility managers out the most? Trying to please everyone (33%), followed by an impending survey (26%) and staff management (24%), according to the results of last week's poll, taken by 463 of you.