anesthesia risk

8/10/2019 Anesthesia Risk

1/46

Injuries associated withanesthesia

DR. Ghaleb Nasrallah

Head OR&AN. Dept.


2/46


3/46


4/46


5/46


6/46


7/46


8/46


9/46


10/46


11/46


12/46


13/46


14/46


15/46


16/46


17/46


18/46


19/46


20/46


21/46


22/46


23/46


24/46


25/46


26/46


27/46

The 10 most common causes of intra-op.cardiac arrest attributable to anesthesia

1. Drug overdose or selection error------ 15.3%2. Serious arrhythmia ---------------------- 13.9%3. Myocardial infarction, ischaemia ----- 8.8%

4. Inadequate airway management ---- 7.9%5. High spinal ---------------- ---------------- 7.4%6. Inadequate vigilance ------------------- 6.9%7. Massive haemorrhage managed badly 5.1%8. Overdose of inhaled anaesthetic ------- 2.8%9. Suffocation, aspiration ------------------- 2.8%10.Dis/misconnection ----------------------- 2.3%


28/46

Factors involved in deathsattributable in part to anesthesia

failure of a trainee to consult a more senior anesthetist inadequate monitoring inappropriate drug doses poor standard of practice Failure to apply knowledge Lack of care Failure of organization Lack of experience Lack of knowledge Drug effect Failure of equipment

Fatigue


29/46

The most commonly quoted critical incidentsin the Australian Incident Monitoring Study

Problems with breathing system Disconnections Misconnections Leaks

Problems in administration of drugs Overdosage Underdosage Wrong drug


30/46

The most commonly quoted critical incidents inthe Australian Incident Monitoring Study cont.

Problems with intubation and control of airway Failed intubation Oesophageal intubation

Endobronchial intubation Accidental or premature extubation Aspiration

Failure of equipment Laryngoscopes Intravenous infusion devices Breathing system valves Monitoring devices


31/46

Human errors

Wrong drug administration -----------------24% Misuse of anesthetic machine--------------22% Problem with airway management--------16% Problem with breathing system-------------11% Fluids therapy mismanagement-------------5% IV. Therapy disconnection---------------------6% Failure of monitoring----------------------------4% Others-----------------------------------------------12%

Mismatched blood.,n2o or co2 instead of o2 .

Examples of the commonest factors associated


32/46

Examples of the commonest factors associatedwith critical incidents in the Australian Incident

Monitoring Study Inattention/carelessness Inexperience Haste Failure to check equipment Unfamiliarity with equipment Poor communication Restricted visual field or access

Failure of planning Distraction Lack of skilled assistance Lack of supervision Fatigue and decreased vigilance


33/46


34/46

Important complications of GA

pain Nausea and vomiting - up to 30% of patients Damage to teeth - 1 in 4,500 cases Sore throat and laryngeal damage Anaphylaxis to anaesthetic agents - figures such as 0.2%

have been quoted Cardiovascular collapse Respiratory depression Aspiration pneumonitis - up to 4.5% frequency has been

reported; higher in children

Hypothermia


35/46

Important complications of GA cont. Hypoxic brain damage Nerve injury 0.4% in GA and 0.1% in RA Awareness - up to 0.2% higher in obst & cardiac pts. Embolism - air, thrombus, venous or arterial Backache Headache Idiosyncratic reactions related to specific agents - eg,

MH with suxa, succinylcholine-related apnea Iatrogenic - eg, pneumothorax related to C.L.insertion Death


36/46

Important complications of RA

Pain - 25% of patients still experience pain despite spinalanaesthesia

Post-dural headache from cerebrospinal fluid (CSF) leak Hypotension & bradycardia through blockade of the

sympathetic nervous syst. Limb damage from sensory and motor block Epidural or intrathecal bleed Respiratory failure if block is 'too high' Direct nerve damage


37/46

Important complications of RA CONT.

Hypothermia Damage to the spinal cord - transient or permanent Spinal infection

Aseptic meningitis Haematoma of the spinal cord - enhanced by use of

LMWH pre-operatively Anaphylaxis Urinary retention Spinal cord infarction Anesthetic intoxication


38/46

Important complications of LA

Pain. Bleeding and haematoma formation. Nerve injury due to direct injury. Infection. Ischaemic necrosis.


39/46

Where Safety Starts ?

Patient

Facilities, Equipment, and Medications Anaesthetists Skill

Surgeons Skill


40/46

Anesthetist Skill Learn one or two alternate method of

Airway skill Practice it in routine cases


41/46


42/46

U n a n t i c i p a t e

d D i f

f i c u

l t

A i r w a y


43/46


44/46


45/46

ConclusionsThe safety of patients does not depend solely onthe application of standards of practice,the purchase of new equipmentand the institution of new monitoring techniques.

Safety can be increased only byCombining the use of modern technologywith improvements inEducation, Training, Supervision, Attitudes,Standards of clinical practice, Audit and Vigilance


46/46

Reference http://www.patient.co.uk/doctor/important-

complications-of-anaesthesia British Journal of Anaesthesia 95 (1): 95 109 (2005) doi:10.1093/bja/aei132 Advance Access publication

May 20, 2005 University Department of Anaesthesia, The University

of Nottingham, Queens Medical Centre,

Nottingham NG7 2UH, UK *E-mail: [email protected]

anesthesia risk

Documents