Injuries associated with Anaesthesia

1
Injuries associated with Anaesthesia

• British Journal of Anaesthesia Jul 2005

2

• Anaesthetized patient is at risk of complication
• Actions or inaction of the anesthetist
• Actions of the surgeon
• Failure or malfunction of anesthetic equipment
• Unconsciousness airway obstruction
• Pharmacologic muscle paralysis artificial
  ventilation

3
Estimates of mortality
4

• One of the problems with comparison
• Different criteria were used to define anesthetic
  death
• All deaths occurring before the time of transfer
  of the patient from the operating theater or from
  the recovery room
• Within 24-48h after anesthesia

5
(No Transcript)
6
(No Transcript)
7
(No Transcript)
8
Estimates of morbidity

• Pedersen (1994)
• Very high incidence (9) of intraOP
  cardiopulmonary complications associated with
  anesthesia or surgery
• Regional anesthesia was safer in elderly pts with
  COPD who underwent major orthopedic surgery

9

• Cooper et al.
• ICU admissions as a result of serious Cx of
  anesthesia
• 2 of ICU admissions
• Related to Cx of anesthesia (1 in 1543)
• Most Cx (62) in the recovery period
• Respiratory or cardiovascular systems
• One quarter of the Cx avoidable
• 17 of the pts died

10
(No Transcript)
11
(No Transcript)
12
Severe brain injury

• Severe hypoxemia
• Inadequate ventilation
• Severe lung disease
• Delivery of an inappropriately low inspired
  oxygen concentration
• Bronchospasm
• Endobronchial intubation
• Hemo- or pneumothorax

13

• Cerebral ischemia
• Profound hypotension
• Vasodilatation
• Adverse effects of drugs or anaphylaxis
• Severe hypovolemia
• Greatly reduced cardiac output
• cardiac failure
• Cardiac arrest
• Severe bradycardia
• Malignant arrhythmia

14
(No Transcript)
15
(No Transcript)
16
(No Transcript)
17
(No Transcript)
18
(No Transcript)
19
Drug administration errors

• Common source of injury
• Omitted, repeated, substituted, given in error,
  given in an incorrect dose, or given by an
  incorrect route
• Most drug administration errors are harmless, but
  some are not
• Succinylcholine, inhaled anesthetic agent,
  opioids, local anesthetics, epinephrine,
  cardiovascular agents, antibiotics, and
  non-depolarizing neuromuscular blocking drugs

20
Awareness during general anesthesia

• Result of provision of inadequate concentrations
  of anesthetic drugs in the paralyzed patient
• The use of an anesthetic technique which is
  predictably inadequate to ensure lack of
  spontaneous recall in all patient
• Failure to check or monitor the use of gas
  delivery equipment
• At, or shortly after, the time of skin incision

21
Obstetric anesthesia

• Regional anesthesia
• Only about one-fifth of non-obstetric claims
• Maternal death
• 42 of claims with general anesthesia
• Only 12 of claims when regional anesthesia

22
Peripheral nerve damage

• Usually the result of compression or stretching
  of the nerve
• Demyelination at a point of localized compression
• Remyelination in 6-8 weeks
• Ulnar and common peroneal nerves
• Particularly susceptible
• Brachial plexus
• Radial nerve
• Sciatic nerve

23
Anaphylaxis

• Exaggerated response of an organism to a foreign
  protein(or other substance)
• Liberation of histamine, serotonin and other
  vasoactive substances
• Clinical manifestation (table 8 and 9)
• Three important factor
• History
• Prompt recognition and appropriate treatment
• investigation

24
(No Transcript)
25
(No Transcript)
26
Damage to teeth

• Most frequent cause of claims
• Not usually expensive
• Difficult or emergency intubation
• Half of the cases
• During extubation or in the recovery room
• 25 of injuries
• Upper left incisor tooth
• Most frequently involved

27
Eye injuries

• Corneal abrasion of blindness
• Result of eye opening
• Movement during ophthalmic anesthesia
• Inappropriate positioning in the prone position

28
Embolism

• Embolism of air or thrombus
• Cerebral ischemia
• Massive venous thrombus
• Great reduction in cardiac output
• Massive pulmonary embolism is unusual during
  anesthesia
• Postoperative embolism is much more common
• Arterial thrombi from heart or great vessel

29
Regional anesthesia

• Cardiac arrest
• Primary reason for death
• Permanent disabling injuries
• M/c cause nerve block of the eye
• Pain management-related claim

30
Spinal cord/nerve root damage

• Spinal or CSE
• Damage to the cervical spinal cord
• Interscalene block under general anesthesia
• Inappropriate substance
• Extensive neurologic damage
• Potassium chloride or calcium chloride
• Result of ischemic lesion
• Systemic hypotension or local occlusion of the
  blood supply

31
Pain during surgery

• Up to 25 of patient
• Pain or discomfort under regional anesthesia
• Particularly during Cesarean section
• Specific consent

32
Miscellaneous injuries

• Pain related to administration of succinylcholine
  very common
• Fractured ribs and other injuries
• Skin necrosis
• Laryngeal damage
• Pneumothorax
• Hypothermia
• Burns

33
Conclusions

• Many claims has decreased
• could have been prevented
• Safety can be increased only by
• Combining the use of modern technology with
  improvements in education, training, supervision,
  attitudes, standards of clinical practice, audit,
  and vigilance