I was interested to read the recent article by Marr et al. . Introduction of uniform colour coding of syringe labels in 2003 was the result of a joint initiative by the Association of Anaesthetists of Great Britain and Ireland, the Royal College of Anaesthetists, the Intercollegiate Faculty of Accident and Emergency Medicine and the Intensive Care Society . This practice, already widely used both in North America and Australasia, followed a Department of Health drive to minimise drug administration errors.
Five theatres at our institution are being equipped with dedicated laparoscopic equipment including green ambient lighting, to reduce eye strain among personnel. Working in these theatres has posed a new challenge for the anaesthetist: the green lighting alters the appearance of the colour system on the syringe labels (Fig. 3). Based on colour coding alone, the distinction between opioids and vasopressors is particularly challenging, as is that between anticholinergic and antiemetic drugs. Furthermore, the red label signifying neuromuscular blocking agents is difficult to read.
Of course, there is no excuse for not checking drug names before their administration. However, I believe that the use of coloured ambient lighting, beneficial to our surgical colleagues, introduces potential risk within the anaesthesia ‘sterile cockpit’ . To mitigate this, I would suggest that a white light be available at the anaesthetic work station at all times and that one of the initial management steps in the event of a critical incident be restoration of white ambient lighting.