Drug overdose due to malfunction of a patient-controlled analgesia machine: A case report / 대한마취과학회지
Korean Journal of Anesthesiology
;
: 272-275, 2013.
Article
Dans Anglais
| WPRIM
| ID: wpr-49129
ABSTRACT
Patient-controlled analgesia (PCA) provides excellent pain control and high stability, thereby minimizing the incidence of adverse effects. However, one of our patients experienced respiratory depression and hypotension within 30 minutes of initiation of PCA therapy. We discovered that machine malfunction caused continuous activation of the PCA button, resulting in a drug overdose. The PCA machine was sent to the manufacturer, who found an electrical short in the PCA button. All PCA units of the same make and model were immediately removed from hospitals and replaced with redesigned units without defects in the PCA button. We have used the improved machines without any problems. The purpose of this report is to raise awareness of this type of malfunction in PCA units in order to help prevent adverse events in the future.
Texte intégral:
Disponible
Indice:
WPRIM (Pacifique occidental)
Sujet Principal:
Insuffisance respiratoire
/
Anaphylaxie cutanée passive
/
Incidence
/
Analgésie autocontrôlée
/
Mauvais usage des médicaments prescrits
/
Hypotension artérielle
Type d'étude:
Etude d'incidence
/
Étude pronostique
Limites du sujet:
Humains
langue:
Anglais
Texte intégral:
Korean Journal of Anesthesiology
Année:
2013
Type:
Article
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