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Modern balanced anesthesia consists of the use of a number of drugs to achieve the desired clinical endpoints, such as no awareness, no movement, muscle relaxation, control of blood pressure and control of heart rate in the face of the noxious surgical stimulus. Understanding the methodology used for the study of drug interactions and knowing the interactions that occur between commonly used anesthetic drugs is important for using them effectively and safely.

Objective To evaluate the possibility that anaesthetists are administering potentially pathogenic micro-organisms to their patients. Design Prospective microbiological and observational study in a realistic simulated setting. Participants Ten anaesthetists supported by 10 anaesthetic technicians. Primary outcome measure The presence or absence of organisms cultured from sterile intravenous bags used to collect drugs injected during the simulated cases and from the needles and the contents of the syringes used. The authors also observed the aseptic techniques used. Results Organisms were isolated from five of 38 (13%) bags from five of 20 simulated cases anaesthetised by four of 10 anaesthetists, 10 of 197 (5%) syringes and six of 17 (35%) needles. None of the anaesthetists washed their hands prior to entry, used the hand gel provided, disinfected the phial septa before drawing up drugs or disinfected the intravenous ports on the intravenous administration set before use. One was seen to recap a needle left on a syringe for possible reuse. Three participants were observed to place equipment such as stethoscopes, drug charts and pens on top of their inuse drug trays. Conclusion The administration of intravenous drugs during anaesthesia may be an important factor in the genesis (or potentially the prevention) of healthcare-associated infection. These observations suggest room for improvement in the aseptic techniques of at least some anaesthetists when preparing and administering intravenous drugs. Confirmation of these findings in clinical settings is needed. Study registry number (for the VASER study) Australian New Zealand Clinical Trials Registry: Ref: ACTRN 12609000530224, [https://www.anzctr.org.au/registry/trial_review.aspx?ID=308128][1]; note that the work presented here is a subset of the registered trial and its outcomes were not included in this registration. [1]: http://https//www.anzctr.org.au/registry/trial_review.aspx?ID=308128

Recent studies have demonstrated a reduction in perioperative complications if a surgical safety checklist is utilised. In our institution an adaptation of the WHO Surgical Safety Checklist is administered in 3 "domains": on arrival of the patient in the operating room (Sign In); before surgical incision (Time Out) and before the patients leaves the operating room (Sign Out). Since incomplete administration or staff disengagement could diminish any safety benefit we evaluated administration of this checklist.100 adult surgical cases were observed. Compliance with administration of the Sign In, Time Out, and Sign Out domains and their component checklist items was recorded. The timing of the checklist administration, and engagement of operating room teams were also assessed.The rate (per 100 cases) of the checklist domain administration was: 99 for Sign In; 94 for Time Out; and 2 for Sign Out. The mean (range) checklist item compliance was 56% (27-100%) for Sign In, 69% (33-100%) for Time Out, and 40% for Sign Out. Checklist items related to patient identity and surgical procedure were administered in 100% of Sign In administrations. Timing of the checklist administration was appropriate in over 80% of cases. Engagement by theatre teams was frequently incomplete.The Sign Out domain was almost always omitted, which may increase the risk of important omissions in postoperative care. Most other aspects of checklist administration could also be improved. This will require strong leadership from senior clinicians in all relevant teams.