store expired controlled substances in a secure loca-
tion until they are processed and disposed of by a
third party, notes Dr. Bouchat-Friedman.
Allegheny Valley Hospital's pharmacy has begun
auditing controlled substances used in the OR with
refractometer technology. "We can test injectable
medications, both undiluted and prepared, at specif-
ic concentrations in the OR, all of which have an
identifiable signature," says Dr. Bouchat-Friedman.
"By using software to compare the sample against a
known database, we can determine if diversion
might be taking place. Regular auditing is a net-
work-wide safety measure due to anesthesia profes-
sionals having such a high incidence of abuse in
their profession."
3. You should spike IV solutions within how many
hours of their intended use?
a. one
b. two
c. three
d. four
Answer: a
Association for Professionals in
Infection Control and
Epidemiology (APIC) and the
United States Pharmacopeia (USP)
indicate IVs should be spiked as
close to the intended administra-
tion time as possible. At the very
least, bags must be spiked within
one hour of their intended use,
according to Sheldon Sones, R.Ph.,
FASCP, president and founder of
Sheldon S. Sones and Associates in
Newington, Conn. "In the past, we
would see several IVs spiked hang-
ing for use the next morning," he
says. "The one-hour rule is now
standard practice."
4. A patient claims to be allergic
to sulfa medications, which have
caused him to suffer major body
rashes. Is it necessary to alert anesthesia of the
reported allergy to sulfas because some forms of
propofol contain sulfites?
a. yes
b. no
Answer: b
Sulfa drugs treat a variety of health conditions,
including common infections, while sulfites are
preservatives used in foods, drinks (especially
wine) and medications. "Sulfa drugs and sulfites
are not related," explains Mr. Sones. "Neither are
their allergies, so there is no need to worry about
administering propofol to a patient who is allergic
to sulfas."
5. How much dantrolene is needed to treat malig-
nant hyperthermia in a patient weighing 70 kg?
a. 500 mg
b. 600 mg
c. 700 mg
Answer: c
An initial dose of dantrolene at 2.5 mg/kg is recom-
mended, with a suggested upper limit of 10 mg/kg.
Standards and recommendations from the
4 8 • O U T P A T I E N T S U R G E R Y M A G A Z I N E • F E B R U A R Y 2 0 2 1
HIGH RISK Opioids, benzodiazepines and amphetamines are the most commonly diverted controlled substances.
