Mortalilty

Question 1

What increases dogs chances of anesthetic death

Answer 1

Poor health status (6.6x increase)
Procedural urgency (2.6x increase)
Age >12 years (7x increase)
Body weight <5kg (8x increase)
Halothane (6x increase)

Question 2

What are the mortality rates of dogs in the 48 hours post op

Answer 2

GA: 0.18%
ASA 1-2: 0.05%
ASA 3-5: 1.33%

Question 3

What increases the cahnce a cat will die with anesthesia

Answer 3

Poor health status (Increasing ASA status: 3x increase)
Procedures
Urgency (Emergency: 1.6x increase)
Complexity of Sx (Major vs minor: 3x increase)
Extremes of weight
Cats: < 2 kg: 16x increase
Cats > 6 kg: 3x increase
Age: > 12yrs: 2x increase
Endotracheal intubation (2x increase)
Fluid therapy (4x increase)

Question 4

How do you decrease mortality with anaesthesia

Answer 4

Monitoring
Use of pulse oximetry (3-4x decrease)
HR continuously monitored
No drugs associations

Question 5

Evidence based approach to reduce mortality

Answer 5

3 recommendations
Improve pre anaesthetic medical management
Anesthetic regime for sick patients (>= ASA 3)
Premed – propofol – iso
Limit epidural combination of bupivacaine and morphine
Take home message
Stabilize patient first
Use a balanced anaesthesia protocol
Epidural recommendations were specific to that practice

Question 6

How can you reduce mortality with anesthetics

Answer 6

Improve monitoring
- Trained technician to administer and monitor anesthesia
- Use of monitoring equipment
Improve supportive care
- Improve health status
- Adequate preoperative workup
- Stabilize patient
- Adequate anaesthesia protocol
- Supportive care that extends into the recovery period
Improve health status of patients
- Always perform preanesthetic physical exam
- Stabilize patient
- Identify problems pre op
- Stabilize the patient’s condition prior to anaesthesia
- Understand pathophysiology
- Anesthetic agents
- Cardiovascular depressants
- Inhibit normal compensation mechanism

Question 7

High mortality rate in recovery is casued by and how to fix

Answer 7

Transition from 100% O2 to room air
Still under influence of anaesthetic agents
Hypothermic – shivering
Transition from constant to intermittent monitoring
Examples to counter these effects
Continue to warm patients
Instigate post op monitoring system
Dedicated person
Provide O2
Provide fluid therapy

Question 8

How do medical errors contribute to mortality rates during anesthetics

Answer 8

Medical error is significant contributing factor in majority of anesthetic fatalities
Failure to provide appropriately trained staff
Lack of experience/ knowledge
Failure to apply knowledge correctly
Lack of care and attention
Inadequate monitoring/vigilance
Poor standards of practice
Failure to check equipment

Question 9

Practical strategies to prevent human errors

Answer 9

Checklists
SOPs
Patient safety incident reporting

SOPs
Most of us use SOPs without realizing it
SOPs need to be servants not masters
Need to be continuously updated
Can be overridden when justifiable circumstances dictate