In 1954, a paper on the deaths associated with anaes-thesia and surgery identified an overall anaesthetic mortality of 1 in 1560.
HISTORICAL PERSPECTIVES
In
1954, a paper on the deaths associated with anaes-thesia and surgery identified
an overall anaesthetic mortality of 1 in 1560, but when the neuromuscular
blocking drug curare (tubocurarine) was administered, the mortality rate was up
to six times higher than those who did not receive the drug (Beecher and Todd,
1954). In hindsight, it was the anaesthetic manage-ment that was at fault and
not an adverse drug event. The introduction of the drug had created a scenario
where airway management became a critical issue. Nevertheless, this report highlights
the importance of drug post-marketing surveillance of morbidity and mortality
to improve patient safety during anaesthesia and critical care.
In
the United Kingdom in the late 1970s, Lunn and Mushin identified the
pharmacological causes of anaesthetic deaths as being caused by drug overdose,
drug interactions and genetic susceptibility such as malignant hyperthermia
(Lunn and Mushin, 1982). It was recognized in the Lunn and Mushin report that
almost all the reactions reported the use of suxam-ethonium. This association
was considered to reflect the situation where patients were requiring
emer-gency surgery and were likely to be critically ill. Hence, the causation
of the reaction was likely to be multifactorial rather than a direct
consequence of suxamethonium use.
The
incidence of drug usage is critical to reporting systems and is often an
unknown quantity. It was in the 1970s and early 1980s that collaborations
devel-oped to identify the problems associated with allergies to anaesthetic
drugs in the Australian continent and Europe. Over the past 30 years as a
result of these initiatives, regular reports and significant advances in the
identification and management of anaphylactoid reactions have occurred (Mertes
and Laxenaire, 2002).
Historically,
many drugs have been withdrawn in the United Kingdom or their use curtailed
because of adverse effects. These include
• althesin – because of allergic phenomenon with an incidence of 1 in 11 000–19 000 (Clarke and Watkins, 1993);
• methoxyflurane – because of renal toxicity (Reichle and Conzen, 2003); and
• halothane – because of hepatic dysfunction (Reichle and Conzen, 2003).
Related Topics
TH 2019 - 2024 pharmacy180.com; Developed by Therithal info.