Another problem with prefilled succinylcholine

Abstract

We would like to report an unexpected incident during a Caesarean section (LSCS). In our hospital, drugs used for emergency LSCS are drawn up by the anaesthetist and kept in a tray along with a prefilled syringe of succinylcholine in its original package (Aurum Pharmaceuticals, Romford, UK). Only prefilled syringes of succinylcholine are available in the obstetric theatre and it is assumed that a box with an intact seal will contain a prefilled syringe. Rapid sequence induction for foetal distress was commenced in the usual manner. (Regional anaesthesia was precluded due to the urgency of the case). When the sealed box of succinylcholine was opened, it was found to be empty. We would like to highlight that the box is not easy to open in an emergency; that it is impossible to predict whether there is anything inside the box without breaking the seal, and that it may be possible to open the box, remove the syringe and close the box leaving the seal intact. This may have accounted for the critical incident described above. Aurum Pharmaceuticals have been informed of the incident. We request that the packaging is modified so that it is easier to open the box, that it is possible to check the contents without opening the box and that it is impossible to re-close the box once it has been opened.