Complications - Quiz 3 Flashcards by Donny Le

Within how many days can Perioperative Mortality occur?

2-30 Days

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What is a Six-Sigma Defect Rate?

99.999% of cases are free of defect

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What is Morbidity?

What are the Minor Incidences?

Any complication other than death

Hoarseness - watch cuff pressures
PONV
Drug Error
Equipment Malfunction

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What are the Goals of the ASA Closed Claims Project?

Identify Major Areas of Loss
Identify Patterns of Injury
Identify Prevention Strategies

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What are some Unpreventable Anesthetic Mishaps?

Sudden Death Syndrome

Fatal Idiosyncratic Drug Reactions

Poor Outcomes even with Proper Management

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What are the Top 3 ASA Closed Claims?

Death, Injury, and Nerve Damage

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What are the ASA Emerging Claim Areas?

Regional Anesthesia

Chronic Pain Management

Acute Pain

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What are some Human Errors that lead to Preventable Anesthetic Accidents?

Med Errors

Airway Mismanagement

Gas Machine Misuse

Fluid Mismanagement

IV Line D/C

Unrecognized Circuit D/C

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What are the Factors associated w/ Human Error & Equipment Misuse?

Poor Preparation
Poor Experience/Training
Environmental Limitations
Physical/Emotional Factors

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What are ways to Prevent Anesthetic Complications?

Improve Patient Monitoring, Techniques, & Education
Protocols & Standards
Active Risk Management Programs

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How do Anesthetic Agents effect the Pediatric Brain?

Prolonged/Multiple procedures = Developmental Delays

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Which type of Airway Injury is usually 99% the fault of the Anesthesia Provider?

Dental Injury

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Why is Patient Positioning Important?

Risk for Peripheral Nerve Damage

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Which Position can cause an Air Embolism?

Sitting

Prone

Reverse Trend.

Prevention: Keep venous pressure > 0 at the wound

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Which Position can cause Alopecia?

Supine

Lithotomy

Trend.

Prevention: Normotension, padding, rotate head

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Which Position can cause Compartment Syndrome

Lithotomy

Prevention: Maintain Perfusion Pressure & Avoid External Compression

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Which Position can cause Corneal Abrasion?

Prone

Prevention: Tape & Lubricate eyes

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Which Position can cause Retinal Ischemia/Blindness?

Prone & Sitting
(Due to Hypotension)

Prevention: Avoid Globe Pressure

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Which position can cause Backache, Digit Amputation, Nerve Palsies, And Skin Necrosis?

Any Position

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How do you prevent Brachial Plexus damage?

Avoid stretching or direct compression at neck or axilla

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How do you prevent Radial Nerve Damage?

Avoid Lateral Humerus Compression

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How do you prevent Ulnar Nerve Damage?

Padding at Elbow & Forearm Supination

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What are some symptoms after a patient experiences awareness?

Anxiety

Nightmares

PTSD

Social Problems

What are High-Risk cases for Awareness?

Major Trauma

Obstetrics

Cardiac Surgery

What are the Risk Factors for Awareness?

Female Young Obese Clinical Experience Prior Awareness After Hours Emergency Procedures Use of Muscle Relaxors

What are some ways you can prevent Intraoperative Recall?

Set Expectations w/ Patient Give Right Dosage & Amnesic Meds Document ET Gas Concentration Use BIS

When does the onset of Ischemic Optic Neuropathy occur?

Immediately to 12th Post-Op Day

How can you prevent Ischemic Optic Neuropathy?

Head Up Minimize Abdominal Constriction Monitor BP Limit Hypotension Avoid Anemia Procedural Staging

What is the most common Cardiovascular Event after Non Cardiac Surgery?

Myocardial Infarction 5% of patients \> 45 yo

How can a high level of spinal block at the T4 level effect the patient?

Cardiopulmonary Arrest Happens 18-54 minutes after insertion

What are the signs and symptoms leading to arrest from Spinal Anesthesia?

Gradual decline in HR & BP (20% \< Baseline) Cyanosis

How can Spinal Anesthesia cause Hearing Loss?

CSF Leak Treat w/ Blood Patch?

How can General Anesthesia cause Hearing Loss?

Middle Ear Barotrauma Vascular Injury Drug Ototoxicity Surgical Manipulation S/P CPR

What are the types of Hypersensitive Allergic Reactions?

1. Immediate - Atopy, Urticaria, Anaphylaxis 2. Cytotoxic: - Hemolysis, HIT 3. Immune Complex 4. Delayed, Cell-Mediated - Contact dermatitis, Graft Rejection

What would an anaphylactic reaction look like?

Respiratory Distress and/or Circulatory Shock Can die from choking or irreversible shock

What are Mediators of Anaphylaxis?

Histamine Leukotriens Prostaglandin Platelet-Activating Factor Tumor Necrosis Factor

What is the difference b/t Anaphylactic and Anaphylactoid Reactions?

They look the same, but Anaphylactoid doesn't depend on IgE Antibody interaction w/ Antigen

How do you treat Anaphylactic Reactions?

* Stop giving the Med * 100% O2 * Give Epi, Benadryl, Ranitidine, Steroid * Intubate/Trach * Fluid Bolus

What drugs are the most common causes of Allergic Reactions?

Muscle Relaxants - Roc, Sux

Which type of Local Anesthetics have more risk for allergic reactions?

Esters

What is the 2nd most common cause of Anaphylaxis during anesthesia?

Latex - mild to life threatening Should Absolutely Avoid Latex Use

What is a late sign of Malignant Hyperthermia?

Increased Core Temperature

What causes Malignant Hyperthermia?

All gases & Sux

How does Dantrolene Work?

Binds to Ryr-1 Receptor and directly stops muscle contraction & calcium release. 2.5mg/kg q5 min Max Dose: 10mg/kg

What is the greatest complication after giving Dantrolene?

(Relatively safe) Muscle Weakness, Resp. Insufficiency, & Aspiration

What are signs of Bronchospasm?

Prolonged Expiration High Inspiratory Pressure Exp. Wheeze Decreased O2 Sat

The presence of what three things at the same time can cause a Fire in the OR?

Cautery Oxygen Alcohol Prep

Steps to take after Complications happen

1. Prevent more injury 2. Report Incident 3. Analyze Cause 4. Disclosure - talk openly, timely, accurately & express regret

What is a Critical Event

When a complication occured or had the potential to occur

What is a Sentinal Event?

When a **serious** complication occured

What positions causes Common Peroneal Palsy?

Lithotomy, Lateral Decubitus Prevention: Pad upper fibula

Ischemic Optic Neuropathy is common reported after which procedures?

Cardiopulmonary Bypass Radical Neck Dissection Abdominal & Hip Procedures Spinal Surgery in Prone Position

What patient factors would put them at risk for Ischemic Optic Neuropathy?

HTN DM CAD Smoking

Other than MH, what else can Dantrolene be used for?

Neroleptic Malignant Syndrome & Thyroid Storm Hyperthermia

What is the difference between Complete and Partial Laryngospasms?

**Complete**: silent, pardoxial chest movement, tracheal tug, no ventilation **Partial**: Crowing noise, mismatch of breathing effort & effectiveness

To reduce fires during a tonsillectomy, what should you keep the FIO₂under?

Keep FIO2 \< 30% (And wait 3 minutes for chloraprep to dry)