I attended Dr. David Caraway’s lecture, entitled “Challenges and Adverse Events in IT Infusion.” During this presentation, Dr. Caraway reviewed a mortality and morbidity article in the Journal of Anesthesiology by Dr. Robert Coffey – citing that the major cause of deaths secondary to pump implantation was insufficient patient monitoring. He added that an additional factor is concomitant medications used with implantable pump patients; for example, patients who are on oral medications in addition to IT medications. There is a co-morbidity of risk factors associated with pump patients.

Dr. Caraway also discussed the Medtronic pump stall failure letter that was issued in November 2012. He cited that the standard of care is different from the FDA approved medications, as noted in this memo. The motor stall data is available online; and it was collected from 2003 to 2011. Dr. Caraway noted the major point that the pump stall failures do not lead to overdosing! In this memo, there is no data suggesting an increase in mortality secondary to motor stall. In fact, catheter failure is higher than pump failure. Dr. Caraway also indicated that the Polyanalgesic Consensus Committee’s recommendations were for off label use medications.

Dr. Caraway’s presentation also reviewed information relating to drug distribution within the intrathecal space. He cited some of the studies and publications by Dr. Christopher Bernards where Dr. Bernards work studying the pig model showed greater distribution with higher volume infusion rates. What was even more interesting, however, was that there was greater distribution both anterior and posterior of the catheter tip.

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