AP Exam 4 part VII Flashcards
dramatic improvement of mortality in anesthesia secondary to __________________
safety monitoring
what is safety monitoring
extending human senses through electronic monitoring
what 3 complications account for the greatest percentage of death in anesthesia
- adverse effects of anesthesia in therapeutic use (>40%) 2. opioids and analgesics (~20%) 3. unspecified G.A and unspecified anesthetic both (>10%)
mortality percentage in OB
3.60%
mortality percentage that is due to cardiac complications
2.70%
mortality percentage r/t difficult airway
2.30%
mortality percentage r/t MH
1%
which components of anesthesia are seeing an increase in mortality malpractice claims?
- regional (16%) 2. chronic pain management (18%) 3. Acute pain (9%)
deaths related specifically to surgical anesthesia has ______________
decreased
as physical status classification increases, the mortality rate from anesthesia __________________
increases
what is the most common complication of anesthesia in the ASA closed claims project data base
death
physical status 1
normal healthy patient, no functional limitations
physical status 2
mild system dz, but no fx’al limitations (controlled HTN, asthma, DMT2, tobacco, pregnancy)
physical status 3
patients with mod-severe dz with some fx’al limitation (poor controlled HTN/COPD/CHF/CAD with old MI, morbid obesity)
physical status 4
pts with severe systemic dz that is a constant threat to life, possiblity of death (unstable angina, sx’atic COPD with supplemental O2, hepatorenal failure)
physical status 5
pts who are moribound, not expected to survive without the operation
physical status 6
pts declared brain dead, organ donors
define morbidity
indicative of dz, incorporating any complication during the perioperative period, excluding death
most common events leading to injury (morbidity) in anesthesia claims
- regional (20%) 2. Respiratory events (17%) 3. CV events (13%) 4. equipment problems (10%)
minor morbidity
moderate distress without prolonged hospital stay, no permanent complications
PONV would be an example of what type of morbidity
minor
intermediate morbidity
serious distress prolonging hospital stay, no permanent complications
dental injury during surgery would be what type of morbidity
intermediate
major morbidity
permanent disability ro complication
spinal cord injury or anoxic brain injury are examples of wht type of morbidity
major morbidity
which anesthesia morbidity claims are increasing?
- acute pain (8%) 2. chronic pain (18%) 3. MAC (10%)
what morbidity claims in anesthesia are decreasing
obstetrics
claims of morbidity in regional anesthesia have had what trend?
remained steady
incidence of minor morbidity in anesthesia are ____________ (high/low)
high
what are some examples of common minor morbidity (adverse outcomes) with anesthesia
- hoarsness 2. PONV 3. accidental dural puncture 4. equipment malfunction 5. medication error
human errors are the contribution to _______________% of anesthesia related morbidity and mortality
51-77%
what factors of human error have been identified as contributing to most anesthesia related morbidity and mortality
- lack of team work 2. communication breakdown 3. absence of help
what is the 7th leading cause of pregnancy related mortality?
anesthesia complications
what are important risk factors that increase risk of mortality in anesthesia related maternal (OB) mortality
obesity and AA race
what is the greatest challenge anesthesia providers face with pts of advanced age?
preventing, detecting, and managing M&M
______________ is characterized by subtle deterioration in cognitive fx such as: memory deficits, difficult concentration, impaired comprehension, and delayed psychomotor speed
POCD
POCD has what effects on quality of life
- inability to work 2. decline in ADLs 3. possibly need for assistance
establishing ___________________ in the advanced age population prior to surgery is critical
baseline cognitive fx (b/c cognitive impairment could be present prior to surgery)
prevention of POCD
- maintain oxygenation and perfusion 2. surgeries short and minimally invasive as possible
_______________ is a biologic state associated with multisystem physiologic deterioration
frailty
primary fraility
intrinsic process of aging
secondary frailty
end stage of chronic illness (CHF/COPD), and is caused by inflammation and wasting
physiologic parameters for testing fraility
- grip strength 2. weight loss 3. walking speed 4. energy level 5. physical activity
“frail” older adults (those with fraility) are more likely to have _______________ post operatively, and have ________________ resistance to stressors
adverse outcomes; decreased
intraoperative cardiac arrest is a _____________ factor, not a ______________ factor
concomitant; causative
cardiac arrest during neuraxial anesthesia is _________________ frequent compared to general
less
categories of causative factors of perioperative cardiac arrest
- preoperative complications (65%): comorbidities, inadequate risk estimation, misjudgment/human error 2. surgical procedures (24%): excessive surgical bleeding 3. intraoperative pathologic events (9%): MI, PE, arrhythmia 4. anesthetic management (2%): airway, med error, infusion/transufion mishap
_________________ is the leading cause of death in the US with ______% of patients dying before reaching emergency assistance
sudden cardiac arrest ; 95
________________ is the most common underlying cause of sudden cardiac arrest in young athletes
hypertrophic cardiomyopathy: long QT syndrome
what parts of anesthesia provokes hypertrophic cardiomyopathy (long QT syndrome) in those pts without previous dx or abnormal preoperative clinical finiding
induction/intubation/sympathomimetics
