Causes and consequences of anti-infective drug stock-outs.

Anti-infective drugs stock-outs are increasingly frequent, and this is unlikely to change. There are numerous causes for this, mostly related to parameters difficult to control: i) 60 to 80% of raw material or components are produced outside of Europe (compared to 20% 30 years ago), with subsequent loss of independence for their procurement; ii) the economic crisis drives the pharmaceutical companies to stop producing drugs of limited profitability (even among important drugs); iii) the enforcement of regulatory requirements and quality control procedures result in an increasing number of drugs being blocked during production. The therapeutic class most affected by drug stock-outs is that of anti-infective drugs, especially injectable ones, and many therapeutic dead ends have recently occurred. We provide an update on this issue, and suggest 2 major actions for improvement: i) to implement a group dedicated to anticipating drug stock-outs within the anti-infective committee in each health care center, with the objectives of organizing and coordinating the response whenever a drug stock-out is deemed at risk (i.e., contingency plans, substitution, communication to prescribers); ii) a national reflection lead by scientific societies, in collaboration with government agencies, upstream of the most problematic drug stock-outs, to elaborate and disseminate consensus guidelines for the management of these stock-outs.

[Suitability of intraoperative autotransfusion]. / Suivi des techniques de récupération de sang en peropératoire.

This work presents the procedure applied by our hospital to assess the quality and security of intra operative autotransfusion. The suitability of the three following variables has to be constantly assessed: performance of the machines to concentrate and wash collected blood, bacterial contamination of processed blood and rate of adverse events. We note that the procedure is applied with participation of medical and nursing staff. Since its setting-up, we note an amelioration of suitable variables.

[Pressure exerted on tracheal cuffs in intubation in the presence of nitrous oxide]. / Pressions exercées sur la trachée par les ballonnets des sondes d'intubation en présence de protoxyde d'azote.

OBJECTIVE: To compare the time course of endotracheal tube cuff pressures in presence of nitrous oxide (N2O), obtained in a tracheal model with those measured during clinical anaesthesia. STUDY DESIGN: Experimental and clinical prospective study. MATERIAL: Twelve brands of low-pressure tracheal tubes. METHODS: The pressure changes in the cuffs were measured over a three-hour-period in presence of a N2O (50 vol%)/O2 (50 vol%) mixture and mechanical ventilation, the tube being inserted either in a tracheal model or in the trachea of patients during general anaesthesia. RESULTS: The results obtained in vitro were correlated with those measured in the patients. Therefore the tracheal model is a helpful guide for the choice of endotracheal tubes.