Clinical and technical DRPs are frequently observed in primary care as well as in hospital discharge prescriptions. The modified PCNE classification system, especially the amendment with a technical DRP category, proved to be useful and allowed the classification of all DRPs. Neither the setting (hospital discharge vs. primary care) nor the quality of electronically printed prescriptions, but only the number of prescribed drugs influenced the occurrence of clinical or technical DRPs.

Objectives: Opioid-free anesthesia is used increasingly often in hospitals around the world. In this type of anesthesia, opioids are replaced by other analgesics, such as ketamine, lidocaine, dexmedetomidine, and magnesium sulfate. Many clinicians prepare these agents as dual, triple, or quadruple admixtures within a single syringe. However, data on the stability of the individual substances within these preparations over time and in different storage conditions is very limited. Here, we aim to investigate various admixture of dexmedetomidine, ketamine, lidocaine, and magnesium sulfate with respect to the stability of the individual agents over time at different storage conditions. Methods: An ultra-high performance liquid chromatography method coupled to mass spectrometric detection was developed and validated to determine the stability of lidocaine, ketamine, and dexmedetomidine. Quantification of magnesium was carried out in parallel by potentiometric titration. Results: Our results demonstrate the stability of dual, triple or quadruple mixtures of selected substances in 0.9% saline under different storage conditions. Under all conditions, analyzed admixtures remain stable for at least 8 weeks. The quadruple mixture of lidocaine, ketamine, dexmedetomidine, and magnesium sulfate was storable for as long as 148 days without a significant loss of analyte. Conclusion: A new chromatographic method was successfully developed to analyze the stability of various pharmacological agents commonly used by clinicians in opioid-free anesthesia. The data we obtained indicate that mixing these agents together in a single syringe is safe and reliable and suggest that hospital pharmacies may prepare these solutions in advance of planned surgeries.

Anesthesiologists and surgeons are increasingly faced with patients who are under long-term medication. Some of these drugs can interact with anaesthetics or anaesthesia and/or surgical interventions. As a result, patients may experience complications such as bleeding, ischemia, infection or severe circulatory reactions. On the other hand, perioperative discontinuation of medication is often more dangerous. The proportion of outpatient operations has increased dramatically in recent years and will probably continue to increase. Since the implementation of DRGs (pending in Switzerland, introduced in Germany for some time), the patient enters the hospital the day before operation. This means that the referring physician as well as anesthesiologists and surgeons at an early stage must deal with issues of perioperative pharmacotherapy. This review article is about the management of the major drug classes during the perioperative period. In addition to cardiac and centrally acting drugs and drugs that act on hemostasis and the endocrine system, special cases such as immunosuppressants and herbal remedies are mentioned.

In intensive care units (ICU) most of the drugs have to be administered by y-piece infusions or admixtures. Drug stability and compatibility are critical elements in the accurate and appropriate delivery of drug therapies to patients. Five years after the implementation of a simple "colour code system" in an attempt to minimize the number of incompatibilities, the situation has been re-examined. The clinical pharmacist collected 78 different medication regimes and the compatibility and incompatibilities were evaluated based on the available literature. Before initiating the "colour code system" in the ICU, 15% of the administered drugs were incompatible and afterwards the number decreased to 2%. This rate could be kept at 2%, even 5 years after the implementation of the system,without any further intervention. As a result of teamwork between nurses, doctors and clinical pharmacy a simple "colour system" was established to minimize incidences of drug incompatibility in the ICU. The system is highly accepted because the degree of uncertainty has been considerably reduced.

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