Complications - Quiz 3 Flashcards
Current rate of anesthesia related death is ___ per _______ anesthetics. (1999-2005)
1 per 100,000
If you are an ASA 1, how many deaths per 10,000
0.5
If you are an ASA 4, how many deaths per 10,000
5.5
What increases the risk of death during anesthesia?
Comorbidities
What is morbidity?
Any complication other than death
Minor 18-22% incidence
Hoarseness, PONV, drug error or equipment malfunction without injury
Top 3 ASA closed claims
Death - 26%
Nerve injury - 22%
Brain damage - 9%
Top 3 ASA emerging claims
Regional anesthesia 16%
Chronic pain management 18%
Acute pain 9%
What percent of human error is implicated in deaths?
51-77%
What is the major human error that leads to preventable accidents? And what are some other causes?
1 medication error
Unrecognized breathing circuit disconnect
Airway mismanagement
fluid mismanagement
What colors are our labels? Paralytics Narcotics Uppers (epherine, epi, phyenylephrine) Downers nitro Local anesthetics
Paralytics – orange/red Narcotics – blue Uppers (epherine, epi, phyenylephrine) – purple solid Downers nitro – purple strips Local anesthetics – grey
Equipment malfunctions leading to preventable anesthetic accidents:
Breathing circuit (most common) Monitoring device Ventilator Anesthesia machine Laryngoscope
With a circuit malfunction, how do you check it?
Start at patient and work your way back to the machine
New data shows that that what population of pediatrics have increased risk for developmental delays?
Prolonged or multiple procedures (>MAC hours)
tonsillectomy no risk
What are some common airway injuries?
Sore throat – most common Dysphagia Dental injury – most common sued TMJ Vocal cord paralysis Vocal cord granuloma Arytenoid dislocation Esophageal perforation
When positioning a patient, how does hypotension lead to peripheral nerve injury?
less blood flow to that nerve then put pressure on and gets ischemic
What position is air embolism most likely to occur and how can we prevent it?
Sitting/prone/reverse trendelenberg
Maintain venous pressure above 0 at surgical site
What position is alopecia most likely to occur and how can we prevent it?
Supine/lithotomy/trendelenberg
Normotension, padding, head turning
What position is backache most likely to occur and how can we prevent it?
any position
lumbar support, padding, hip flexion
What position is compartment syndrome most likely to occur and how can we prevent it?
esp lithotomy
maintain perfusion pressure and avoid external compression
What position is corneal abrasion most likely to occur and how can we prevent it?
esp prone
tape and lubricate eye
What position is digit ampuateion most likely to occur and how can we prevent it?
any
check for protruding digits before moving hydrolic table
how to avoid a brachial plexus injury
avoid stretching or direct compression of the neck or axilla
What position is common perineal nerve injury most likely to occur and how can we prevent it?
lithotomy and lateral decubitus
pad lateral aspect of upper fibula
how to avoid radial nerve injury
avoid compression of lateral humorous
how to avoid ulnar nerve injury
padding at elbow, forearm supination
What position is retinal ischemia most likely to occur and how can we prevent it?
prone/sitting
avoid pressure on globe
What position is skin necrosis most likely to occur and how can we prevent it?
any position
pad bony prominences
Awareness during general anesthesia is what the general public are must afraid of. What percent of awareness
0.1 - 0.4
When awareness does occur, patient’s may exhibit the following symptoms:
Mild anxiety Sleep disturbances Nightmares Post-traumatic stress disorder Social difficulties
In what cases will awareness happen most?
MAC cases
In high risk cases, awareness happens most often with
major trauma
Why does obstetrics have a higher incidence of remembering?
don’t get versed (because we want them to remember)
Risk factors for awareness
Female Age (younger adults) Obesity Clinician experience Previous awareness After normal hours of operation Emergency procedures Use of nondepolarizing relaxants
Benzodiazepines provide what type of amnesia?
anterograde (forget from time of medication on)
scopolamine provides what type of amnesia?
retrograde (pt will forget that something occurred before)
** has to be given IV
How much MAC should be enough for amnesia?
1/3
What is by far the most common and transient eye injury?
Corneal abrasion
Most common cause of post operative loss of vision.
Ischemic Optic Neuropathy (ION)
What is Ischemic Optic Neuropathy (ION)?
Optic nerve infarction due to decreased oxygen delivery via one or more arterioles supplying the optic nerve.
ION is commonly reported after:
Cardiopulmonary bypass
Radical neck dissection
Abdominal/hip procedures
Spinal surgeries - prone position
Contriribiting factors to ION?
HTN
DM – causes vascular changes (constricted)
CAD
Smoking
Surgical and anesthetic factors that contribute to ION:
Deliberate hypotension
anemia
prolonged surgical time in prone position, head down or compressed abd
When is the onset of ION?
onset is immediately through 12th post-op day
What position will enhance venous outflow to help prevent ION?
position pt head up
Intraop cardiac arrest us usually ________ not _______
concomitant and not causative
Suddent cardiac arrest is usually caused by
hypovolemia
Most common CV event after non cardiac surgery
MI
cardiopulmonary arrest was like to happen because the spinal got to high at a level of
T4
what are the cardiac accelerators?
T1-T4
The higher the spinal, the more _______ the pt will get
hypotensive
Spinal with sedation will likely lead to
hypercarbia
Dermatome
T4 -
T7 -
T10 -
T4 - nipple line
T7 - xiphoid process
T10 - belly button
S/S of cardiopulmonary arrest before it happens
Gradual decline in heart rate and BP (20% below baseline values)
Bradycardia
Hypotension
Cyanosis
medications during cardiopulmonary arrest from spinal anesthesia
ephedrine - alpha/beta agents “baby epi”
Atropine - increase HR
Epi - stron alpha/beta agonist - for bradycardia that is unresponsive to ephedrine and atropine
What is the average duration of CPR from arrest from spinal?
11 min, waiting for spinal to come down
What type of airway is an LMA?
supraglottic airway
Keep in mind for difficult airways!
When perioperative hearing loss does occur, what is it most likely from?
5-% after spinal anesthesia d/t CSF leaks
TXT: blood patch