Understanding Anesthesia Risks for Non-Anesthesia Personnel

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Understanding Anesthesia Risks for Non-Anesthesia
Personnel
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Introduction
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What is the purpose of this presentation?

• Improve understanding of the anesthesia risks
  associated with the outpatient setting.
• Increase patient safety through better
  pre-operative screening and patient selection.
• Decrease patient and provider inconvenience
  related to cancelled procedures due to
  inappropriate patient selection.

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Delimma 1 Cancelled Procedures
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Delimma 2 Negative Patient Outcomes
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Delimma 3 Litagation Related to Negative
Outcomes
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How do we accomplish our objectives?

• Understanding and utilization of the ASA
  anesthesia risk classification system.
• An effective pre-anesthesia evaluation tool.

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ASA Physical Status Classification Guidelines

• ASA I - Normal healthy patient
• ASA II - Patient with mild systemic disease
• ASA III - Patient with severe systemic
• disease
• ASA IV - Patient with severe systemic disease
• that is a constant threat to
  life

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Anesthesia History Allergies

• History of prior anesthesia complications
• -Malignant Hyperthermia
• -Difficult Airway
• -Intractable Nausea Vomiting
• Food and Drug Allergies
• -Demerol
• -Propofol

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Respiratory Issues

• Sleep Apnea
• -have patient bring CPAP
• Asthma
• -types of inhalers
• -frequency of use
• -recent ER visit
• Recent URI/Bronchitis

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Difficult Airways

• Facial Abnormalities
• Hx of Difficult Intubation
• Limited Neck ROM

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Limited Neck ROM
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Mallampati Scoring System
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Cardiac Abnormalities

• Recent MI
• Stents
• AICD
• Uncontrolled HTN
• Arrythmias

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Diabetes Mellitus

• Are blood sugars controlled?
• Does the patient have an established
  medication/insulin regimen?
• Consider checking blood glucose on office
  visit/pre-screening.

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Patients with Potential Increased Anesthesia
Requirements

• Opioid Dependence
• Sedative Dependence
• Illicit Drugs
• ETOH

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Obese Patients

• Morbidly Obese Patients
• BMI gt50
• Sleep Apnea
• Airway Abnormalities
• Comorbidities

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Keys to Developing an Effective System to
Identify High Risk Patients and Avoiding Our 3
Dilemmas

• -Understanding which patients and disease
  processes present increased anesthesia risks
• -Policy development
• -Utilization of an effective pre-anesthesia
  screening tool
• - Communication between facility management,
  staff and anesthesia personnel

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