Anesthesiologists' ability in calculating weight-based concentrations for pediatric drug infusions: an observational study

• Published in: Journal of clinical anesthesia 2014-06, Vol.26 (4), p.276-280
• Main Authors: Avidan, Alexander, MD, Levin, Phillip D., MB BChir, Weissman, Charles, MD, Gozal, Yaacov, MD
• Format: Article
• Language: English
• Subjects: Anesthesia; Anesthesia & Perioperative Care; Anesthesia - methods; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Anesthesiology - standards; Anesthetics - administration & dosage; Attitude of Health Personnel; Biological and medical sciences; Body Weight; Cardiac Surgical Procedures - methods; Child; Computer software tools; Computers; Dopamine; Drug dosage calculation; Drug Dosage Calculations; Drug dosages; Drug Therapy, Computer-Assisted; Humans; Information management; Infusions, Intravenous; Intravenous infusions; Israel; Medical errors; Medical personnel; Medical sciences; Medication Errors - prevention & control; Pain Medicine; Pediatrics; Questionnaires; Success; Surveys and Questionnaires; Tertiary Care Centers; Time Factors
• ISSN: 0952-8180; 1873-4529
• DOI: 10.1016/j.jclinane.2013.11.021

Abstract Study Objectives To assess the ability of anesthesiologists to calculate weight-specific drug concentrations for continuous drug administration in children, and to evaluate the acceptance of an inhouse-developed, computer-based application for calculating drug infusions for pediatric cardiac surgery. Design Observational study. Setting Anesthesiology department of a tertiary-care medical center in Israel. Participants 45 anesthesiology department staff members (attendings and residents). Measurements Anesthesiologists were asked to calculate the weight-based amount of drug and the corresponding amount in mL to be drawn from a standard vial and added to a 50-mL syringe in order to reach an infusion rate, where 1 mL/hr corresponds to 1 μg x kg - 1 x min - 1 . The time it took to reach the result was measured. Staff members were also asked to rate the user-friendliness and usability of the program. Main Results 41 of the original 42 participants returned the completed questionnaire. Only 6 (15%) of 41 anesthesiologists provided all the correct answers. The mean calculation time required was 205 (± 53) seconds. There was no difference in success rate between attendings and residents. Incorrect calculations ranged from a drug concentration 50 times too low up to 56 times too high. Most staff members believed that the computer-based application to perform these calculations reduced errors (65%) and workload (81%), and improved patient treatment (71%). This application was rated as very user-friendly. Conclusions Anesthesiologists have difficulty calculating pediatric drug concentrations for continuous drug infusions. The correct calculations are time-consuming. Incorrect calculations may lead to dangerously high or low doses. A computer-based application to calculate drug concentrations was rated as very useful and user-friendly.