Complications - Quiz 3 Flashcards
Within how many days can Perioperative Mortality occur?
2-30 Days
What is a Six-Sigma Defect Rate?
99.999% of cases are free of defect
What is Morbidity?
What are the Minor Incidences?
Any complication other than death
- Hoarseness - watch cuff pressures
- PONV
- Drug Error
- Equipment Malfunction
What are the Goals of the ASA Closed Claims Project?
- Identify Major Areas of Loss
- Identify Patterns of Injury
- Identify Prevention Strategies
What are some Unpreventable Anesthetic Mishaps?
Sudden Death Syndrome
Fatal Idiosyncratic Drug Reactions
Poor Outcomes even with Proper Management
What are the Top 3 ASA Closed Claims?
Death, Injury, and Nerve Damage
What are the ASA Emerging Claim Areas?
Regional Anesthesia
Chronic Pain Management
Acute Pain
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
What are the Factors associated w/ Human Error & Equipment Misuse?
- Poor Preparation
- Poor Experience/Training
- Environmental Limitations
- Physical/Emotional Factors
What are ways to Prevent Anesthetic Complications?
- Improve Patient Monitoring, Techniques, & Education
- Protocols & Standards
- Active Risk Management Programs
How do Anesthetic Agents effect the Pediatric Brain?
Prolonged/Multiple procedures = Developmental Delays
Which type of Airway Injury is usually 99% the fault of the Anesthesia Provider?
Dental Injury
Why is Patient Positioning Important?
Risk for Peripheral Nerve Damage
Which Position can cause an Air Embolism?
Sitting
Prone
Reverse Trend.
Prevention: Keep venous pressure > 0 at the wound
Which Position can cause Alopecia?
Supine
Lithotomy
Trend.
Prevention: Normotension, padding, rotate head
Which Position can cause Compartment Syndrome
Lithotomy
Prevention: Maintain Perfusion Pressure & Avoid External Compression
Which Position can cause Corneal Abrasion?
Prone
Prevention: Tape & Lubricate eyes
Which Position can cause Retinal Ischemia/Blindness?
Prone & Sitting
(Due to Hypotension)
Prevention: Avoid Globe Pressure
Which position can cause Backache, Digit Amputation, Nerve Palsies, And Skin Necrosis?
Any Position
How do you prevent Brachial Plexus damage?
Avoid stretching or direct compression at neck or axilla
How do you prevent Radial Nerve Damage?
Avoid Lateral Humerus Compression
How do you prevent Ulnar Nerve Damage?
Padding at Elbow & Forearm Supination
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?
- Immediate - Atopy, Urticaria, Anaphylaxis
- Cytotoxic: - Hemolysis, HIT
- Immune Complex
- 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
- Prevent more injury
- Report Incident
- Analyze Cause
- 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 FIO2 under?
Keep FIO2 < 30%
(And wait 3 minutes for chloraprep to dry)
