Indian Journal of Anaesthesia | Vol. 55| Issue 4 | Jul-Aug 2011 428 Letters to Editor Look alike drug labels : A worrying issue Sir, We read your article with great interest and once again we want to emphasize that the problem of look- alike drugs is still continuing. Recently, we have experienced the potentially disastrous problem of look-alike drugs when an ASA1 patient had nausea while undergoing hernia repair and when asked for inj. Ondansetron, an O.T. technician handed over ampoule of inj. Tramadol; however, because of the vigilance of the anaesthesiologist, wrong drug administration was avoided. Although nothing like life-threatening could have happened other than the exaggeration of patient’s symptoms, but instances are reported when even the life-threatening complications occurred with wrong administration of drugs due to similar looking ampoules. [1] While investigating on close inspection, it was found that both 2 ml ampoules have strikingly similar appearance. Inj ONDOC-2 (Ondansetron) is manufactured by Morepen Laboratories Ltd. with embossed printing in red colour whereas inj TRAMADOC (Tramadol Hydrochloride) is manufactured by Pharma Concepts, also with embossed printing in red colour [Figure 1]. Even the snap off dot is of blue colour in both the ampoules. The last three letters (doc) of commercial names are also similar. Although in the majority of the cases, the human factors are responsible in medication error be it fatigue, haste, stress, mixing of drug ampoules in drug cart, poor light, etc., but similarity of drug ampoules like the above-mentioned drugs definitely needs development of improved standards of drug packaging and labelling. Figure 1: Photograph showing almost similar looking ampoules of Inj. Ondoc-2 (Ondansetron) and Inj. Tramadoc (Tramadol Hydrochloride) Vikramjeet Arora, Sukhminder Jit Singh Bajwa, Jasbir Kaur Department of Anaesthesia and Intensive Care, Gian Sagar Medical College and Hospital, Banur, Punjab, India Address for correspondence: Dr. Vikramjeet Arora, Department of Anaesthesia and Intensive Care, Gian Sagar Medical College and Hospital, Banur, Distt. Patiala, Punjab, India. E-mail: suvanarora15@gmail.com REFERENCE 1. Kothari D, Gupta S, Mehrotra A. Look alike drugs- A worrying issue. Indian JAnaesth 2009;53:708-9. Anaesthetic management of a patient with Weill-Marchesani syndrome complicated with mitral regurgitation Sir, Weill-Marchesani syndrome (WMS) is a rare inherited connective tissue disorder characterized by brachymorphy (short stature), brachydactyly (short and stubby fingers), joint stiffness and abnormalities in airway, heart and eye [Table 1]. [1-3] WMS is inherited as autosomal recessive or dominant pattern. [1-3] Anaesthetic management of such a case can be challenging due to associated airway and cardiac problems. [1,2] An eight-year-old boy (height 110.5 cm, weight 16.5 Kg) with WMS was admitted with severe myopia and glaucoma. His ophthalmic examination revealed glaucoma and lens displacement causing high myopia. Anti-glaucoma measures were started. Previous echocardiography showed myxomatous mitral valve (MV) with mitral regurgitation (MR). Repeat echocardiography substantiated that report. There was no history of cyanosis or breathlessness. His physical examination did not reveal any Access this article online Quick Response Code: Website: www.ijaweb.org DOI: 10.4103/0019-5049.84830 This PDF download is supported by MAQUET the makers of FLOW-i – Advancing Anesthesia