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October 04, 2020
10/4/2020 3:00:00 PM - 10/4/2020 4:00:00 PM
Room Virtual
An Increase In Fentanyl Ampule Size Increases Intraoperative Dosing
David Melnick, M.D., Kasra A. Razmjou, M.D.
MedStar Georgetown University Hospital, Washington, Dist. of Columbia, United States
Disclosures: D. Melnick: None. K.A. Razmjou: None.
Background and Aims: There are limited data on the effect of ampule size on drug dosing. One study exists but it only examines the effect of decreasing ampule size and in one surgery type. The objective of this study is to determine the effect of ampule size on perioperative fentanyl dosing when ampule size is increased with a larger sample population.

Materials and Methods: This was a retrospective review of patients undergoing surgery at Georgetown University Hospital during a period fentanyl in the anesthesia Pyxis medication dispensing system were restocked only with 250 mcg ampules compared to a control period in which fentanyl was restocked with 100 mcg and 250 mcg ampules. The primary outcome was anesthesia total administration of fentanyl. Secondary outcome was use of the whole ampule.

Results: A total of 2780 surgical cases were included. Mean total administration of fentanyl per case during the trial period of primarily 250 mcg ampules was 164.2 mcg and during the control period of 100 mcg and 250 mcg was 137.3 mcg. During the control period exactly 100 mcg was dosed in 41% of cases and 250mcg in 5% compared to the trial period of 21% and 22% respectively.

Conclusions: An increase in the ampule size significantly affected total fentanyl dosing by anesthesia. This was explained by the clinician’s desire to avoid the complex process of narcotic waste disposal and the culture of “use the whole vial”.

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