Failure to open outer casing of prefilled succinylcholine syringe
Bibliographic record
Abstract
We would like to report a critical incident which was made worse when the outer casing of a prefilled syringe of suxamethonium (succinylcholine) could not be opened during an emergency situation. During induction of anaesthesia, a patient developed profound laryngospasm after a laryngeal mask had been inserted. It was subsequently removed from the pharynx, but despite administering oxygen 100% with manual CPAP by facemask and Guedel airway, the laryngospasm failed to break, and the patient's peripheral blood oxygen saturation dropped to 70%. A decision was made to use succinylcholine and to intubate the patient; senior help had already been requested. Our hospital now stocks prefilled syringes of succinylcholine (Aurum Pharmaceuticals Ltd, Romford, UK) in the refrigerators of all theatres for such situations (see Fig. 4), although on this occasion the casing could not be opened by me (J.S.D.), the Operating Department Practitioner, or two theatre nurses. Another prefilled syringe was obtained which did open. The patient was given succinylcholine and propofol by which time senior help had arrived. Intubation was secured with a bougie (PT), and the oxygen saturations improved to 100%. The remainder of the anaesthetic and extubation was uneventful, as was the postoperative recovery. Plastic case containing prefilled syringe. Subsequent discussion within our hospital has shown that there have been several occasions on which these plastic boxes have not easily been opened. We have discovered that twisting the casing, as one would wring out wet clothing, breaks all the seals and allows access to the syringe. The manufacturer currently gives no opening instructions. Recent correspondence in Anaesthesia[1–5] indicates that the use of prefilled syringes of succinylcholine is common in other hospitals, removing the need for the anaesthetist to draw up this drug before a list in anticipation of such emergencies. Personal correspondence with the manufacturer has confirmed that currently there is no recommendation on how to open these cases. Aurum have been made aware of this problem, and we believe will shortly be releasing literature with an illustration on the ‘twisting’ action required to break open the casing. Difficulty in opening prefilled syringes can delay further the interval between recognizing the need for succinylcholine and delivery of the drug. This may affect the outcome of a potentially serious clinical incident. We wonder if other anaesthetists have had similar problems in other hospitals? Provision of clear opening instructions from the manufacturers of prefilled syringes should be actively encouraged.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.001 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".