Complications Flashcards
Perioperative Mortality: Death occurs how long after surgery?
Within 48 hrs.
How many anesthesia related deaths per year?
1 : 100,000.
A higher ASA means what perioperative?
> Risk
I .04 : 10,000
II. 0.5 : 10,000
III. 2.7 : 10,000
IV. 5.5 : 10,000
> ASA = > Risk
ASA Lawsuits and Claims (*)
(*) Slide 3. (prob wont be on test but maybe boards.)
Unpreventable things:
- Sudden Death Syndrome.
- Fatal idiosyncratic drug reactions.
- Poor outcomes despite proper management.
Preventable things:
Human Error
Equipment Malfunction
Top 3 Closed Claims in the 90’s
Death 22% (not really most common complication, most common claim).
Nerve injury 18%
Brain damage 9%
3 Emerging Claims:
Regional anesthesia 16%
Chronic Pain Management 18%
Acute Pain 9%
Preventable Human Errors:
- Unrecognized breathing circuit disconnect.
- MEDICATION ERRORS Blue top Vs Orange top.
- Airway mismanagement
- Machine misuse
- Fluid mismanagement
- IV disconnection
4 Factors associated w/ Human Error
- Inadequate preparation
- Inadequate experience
- Environmental limitations
- Physical & Emotional Factors
7 Airway Injuries:
- Sore Throat
- Dysphasia
- Dental injury
- TMJ
- Vocal cord Paralysis & Granuloma
- Arytenoid dislocation
- Esophageal perforation
Peripheral Nerve Injury
Positioning
Hypotension (poor perfusion)
Complication : Position Slide (*)
(*) Look at slide 16
Awareness occurs how often?
0.2-0.4%
Major trauma the lost (43%)
OB (1.5%)
Cardiac Surgery (0.4%)
Preventative Intraoperative Recall
- Consent process
- Define MAC
== MAC 0.6 - Opioids & N2O
== MAC 0.8 - 1.0 when used alone - Yes, use BIS monitor if available
- ET Concentration Documentation
- Amnesia Drug Documentation
3 most common Eye Injuries:
- Corneal Abrasion (most common eye injury)
- Blindness (general, MAC, movement)
- Ischemic Optic Neuropathy (ION)
== most common post operative LOV.
== prone, CPBypass, neck & abdominal
> Risk: HTN, DB, CAD, Smoking
(^) What 3 things compromise venous outflow during surgery?
- Prone
- Head Down
- Compressed Abdomen
Surgical and Anesthesia Factors:
Deliberate Intraoperative Hypotension
Anemia
> Surgical Time (^)
How often can onset occur post-operatively?
12 days
== < Visual acuity-compete blindness
ION Prevention:
> venous BF < Abdominal constriction Monitor BP < duration of hypotension Avoid anemia Staging of surgeries for pts at risk for ION
Cardiopulmonary Arrest during Spinal Anesthesia. Where? How Long? Assoc w/?
- High Level of block (T4) prior to arrest.
- Occurs within 36-18 mins.
- Assoc. w/ resp. depression from >CO2 from sedation. “Just laying there”
Spinals/Epidurals are placed where?
Lower Back
What are the cardiac accelerators?
T1-T4
Spinals/Epidurals affect what first, Respiratory or Cardiac?
Cardiac (Accelerators) T1-T4
Resp C3,C4,C5 “Keep the man alive”
