Complications in Anesthesia

Question 1

What are the complications seen in anesthesia?

Answer 1

1.Airway Injuries
2.Eye Injuries
3. Positional Injury
4.complications of regional anesthesia
5.Complications of central venous cannulation
6.PONV
7,.Awareness
8. Hypothermia
9.Major life threatening complications -
ETT
.Aspiration and Respiratory Complications
.Cardiovascular Complications
.Anaphylaxis
.Equipment failure
Pharmacogenetic diseases

Question 2

What are the airway injuries seen in anesthesia? And what are they caused by?

Answer 2

1. placement of laryngoscope blade, 2.oropharyngeal airway
   3.laryngeal mask airway or ETT

Question 3

What are the risk factors for Airway Injuries?

Answer 3

1.Urgency
2.Poor assessment of the airway,
3. Lack of experience
4.Difficult airway

Question 4

What are the eye injuries seen in anesthesia? And how do you prevent ?

Answer 4

1.Facemask pressure on eyes.
2.Corneal ulceration due to loss of blink reflex due to anaesthesia.

Tap the eye closed.

Question 5

What are the positional peripheral nerve injuries seen in anesthesia? and how are they prevented?

Answer 5

Nerves at risk are
1.Radial nerve(Saturday night palsy)
2.ulnar nerve
3.brachial plexus nerves injuries,
4.lateral popliteal nerve in the lithotomy position(foot drop),
5.femoral nerve damage in Lloyd Davies(extended lithotomy position).

Can be prevented by padding in pressure points

Question 6

What are the complications of regional anesthesia?

Answer 6

High Spinal and total Spinal
Post dura puncture headache
Meningitis
Epidural hematoma
Epidural Abscess
Nerve Injury
Hypotension

Question 7

What are the early complications of insertion of a venous catheter insertion?

Answer 7

1.Technical
Pneumothorax
Heamothorax
2.Nerve damage
3.Dysrhythmias (guide wire related)
4.Air embolism

Question 8

What are the late complications of insertion of a venous catheter insertion?

Answer 8

1.Infection-sepsis
2.Endocarditis
3.Thrombosis
4.tamponade

Question 9

What are the risk factors that cause PONV? And give examples of each?

Answer 9

Anesthetic Factors :
1.Prolonged pre-op starvation
2.Hypotension from spinal or epidural( Other risk factors: bleeding, hypovolemic)
3.Emetic drugs :opiates,etomidate,ketamine,N2O ,Volatile anesthetics

Patient Factors:
Children, females, history of motion sickness, previous PONV, Obesity

Surgical Factors:
Ear or eye surgery, intraabdominal surgery, laparascopy, gynaecological surgery, orchidopexy

Post -op Factors:

Pain, opiates, forced oral fluids too soon, hypotension.

Question 10

How do you prevent PONV?

Answer 10

Avoid emetic drugs
Regional anaesthesia
TIVA with Propofol

As well as pharmacological and non-pharmacological treatment.

Question 11

What is the pharmacological and non-pharmacological management for PONV?

Answer 11

PHARMACOLOGICAL
Anti-emetic drugs
Droperidol
Butyrophenone
Prochlorperazine
Ondansetron
Dexamethasone
metoclopromide

NON-PHARMACOLOGICAL
Keep patient well hydrated

Question 12

What is the cause of awareness in a patient?

Answer 12

Faulty equipment and light anaesthesia.

Question 13

At what temperature is the patient considered to be hypovolemic? what are the consequences of the hypovolemia?

Answer 13

1.Coagulopathy
2.Poor ventilatory efforts
3.Dysrhythmias
4.Slow down metabolism
5.Increased consumption during shivering

Question 14

List ways o prevent Hypothermia

Answer 14

1.Forced air warming blanket (bair hugger)
2.Warm IV fluids and irrigating fluids
3.Warm inhaled gases
4.Warm the theatre temperature if necessary
Note if hypothermia is severe can cause life threatening complications

Question 15

What are the major life threatening complications?

Answer 15

ETT
.Aspiration and Respiratory Complications
.Cardiovascular Complications
.Anaphylaxis
.Equipment failure
Pharmacogenetic diseases

Question 16

What challenges are met during endotracheal intubation?

Answer 16

1.Failure to intubate
2.Dislodge or go too deep resulting in endobronchial intubation
3.Kinking
4.Obstruction with foreign body or secretions

Question 17

What are the consequences of aspiration and respiratory complications?

Answer 17

1.Chemical pneumonitis (Mendelson syndrome) and may result into a fatal ARDS
2.Prolonged ventilation

Question 18

What are the risk factors for Aspiration?(7)

Answer 18

Full stomach
Ileus
Acute abdomen
Hiatus hernia
Pregnancy
Obesity
Gastric outlet obstruction

Question 19

How do you prevent aspiration?

Answer 19

Starving for 6 hours of solid food and for 2 hours atleast of clear fluids prior to elective procedure

Question 20

What are other respiratory complications besides aspiration?(5)

Answer 20

Laryngospasm
Bronchospasms
Airway obstruction
Post operative respiratory depression and hypoventilation
Pneumothorax

Question 21

What are the cardiovascular complications of anesthesia?

Answer 21

Hypotension
Hypertension
Dysrhythmias And Cardiac Arrests
Myocardial Infarction

Question 22

What is the cause of equipment failure and how can it be prevented?

Answer 22

Anaesthetic Machine , ventilator Tubings , vaporisers,intubation Equipment , wiring, And Monitors can all malfunction.
All equipment must be checked prior to anaesthesia.

Question 23

List 4 pharmacogentic diseases

Answer 23

Malignant hyperthermia
Halothane hepatitis
Porphyria
Scoline apnea/Succinylcholine Apnea