Risk in Anesthesia

Question 1

Factors to consider about the choice of technique

Answer 1

—Coexisting diseases

—Risk of aspiration

—Age, cooperation of the pt.

—Coagstatus

—Previous anesthetic/surgical experiences

—Patient desires/beliefs

Question 2

ASA 1

Answer 2

A fit and healthy patient

Question 3

ASA 2

Answer 3

A patient with a mild systemic illness

Ex. Controlled hypertension diabetes

Question 4

ASA 3

Answer 4

A patient with severe but non-incapacitating illness

e.g. uncontrolled HTN, DM with vascular issues, previous MI, COPD

Question 5

ASA 4

Answer 5

A patient with severe incapacitating life-threatening illness

E.g. CHF, renal or hepatic failure, unstable angina

Question 6

ASA 5

Answer 6

A moribund pt who is expecting to die without surgery within 24 hours

Ruptured AAA, PTE, increased ICP

Question 7

ASA 6

Answer 7

Brain Dead

Question 8

Adding E to a ASA clasification

Answer 8

Means Emergency

Question 9

Group A

Answer 9

ASA 1 or 2 with a low risk procedure

Question 10

Group B

Answer 10

ASA 1 or 2 with a high risk procedure

Question 11

Group C

Answer 11

ASA 3 or 4 with a low risk procedure

Question 12

Group D

Answer 12

ASA 3 or 4 with a high risk procedure

Question 13

Cardiac risk in non cardiac surgeries

Answer 13

—Aortic, major vessel, (even some peripheral vessels) surgeries carry a high risk of cardiac related events.

—Intraperitoneal, intrathoracic, carotid, head/neck, ortho, even prostate related surgeries have considerable risk but less than the above.

—Lower risk for cardiac events: Endoscopic, cataract, breast, superficial etc.

Question 14

Disclosure

Answer 14

—Modern medicine and law requires patients/families have all the relevant information with which to make informed decisions.

—Only after patients/family are fully informed of the risks can they be said to have made an informed consent to continue.

Question 15

Disclosure for General Anesthesia

What are the Frequent Complications

Answer 15

These may be frequent but tend to have minimal impact—

Oral/dental damage

—Sore throat/hoarseness post-op

—N/V, drowsiness/confusion, urinary retention

Question 16

Disclosure for General Anesthesia

What are the Infrequent Complications

Answer 16

These are infrequent and are more severe

—Awareness during surgery

—Temp visual loss

—Aspiration, drug reactions

—Malignant Hyperthermia

—Coma

—Death

Question 17

How Safe is Anesthesia

Answer 17

For healthy patient, a planned operation is as dangerous as pregnancy

General anesthesia is generally very safe but there are risk factors

There are very few conditions where anesthesia is likely to be lethal

Anesthesia is very safe and far less dangerous than the effect of surgery

Question 18

Consciousness During Anesthesia

Answer 18

A person who says they are conscious during an operation is not hysterical or insane

These stories should always be taken seriously

Question 19

Hypoxia and Mental Function

Extreme Hypoxia

Answer 19

—SaO2 —<40 causes failure of all brain and brainstem functions, causing loss of consciousness, abnormal, or actual cessation of breathing, and ultimately death.

Question 20

Hypoxia and Mental Function

Severe Hypoxia

Answer 20

—SaO2 40-60

Induces all the effects of moderate hypoxia, except that the degree of brain malfunction is more extreme.

Supplementary and primary motor cortex malfunction so people do not even think of moving, and when a few people do try to move, they discover they are totally paralyzed.

And because severely oxygen starved people do not move, they appear unconscious even though they are often still conscious.

Question 21

Hypoxia and Mental Function

Moderate Hypoxia

Answer 21

—SaO2 60-80

Affect the brain and senses

Removes pain and discomfort making people calm

Supplementary motor cortex malfunction results in a lack of desire to move,

Primary motor cortex malfunction causing muscle weakness for when they do move

More severe degrees of moderate hypoxia may also induce life-review, or out-of-body experiences.

Question 22

Hypoxia and Mental Function

Mild Hypoxia

Answer 22

SpO2 > 80%

Will not affect the functioning of the brain

Question 23

Perioperative lung function

Answer 23

—The lungs must get sufficient oxygen into the body to oxygenate the blood.

—The lungs must eliminate carbon dioxide from the body to prevent carbon dioxide accumulation.

—The patient must be able to generate a productive cough, otherwise mucus accumulation will occur resulting in atelectasis and/or lung infection or pneumonia.

—The patient must be able to significantly increase their respiratory minute volume to compensate for factors such as increased postoperative metabolic rate, elevated body temperature, possible infections, pneumonia, etc.

—Inabilityto significantly raise and sustain an elevated respiratory minute volume results in exhaustion and respiratory failure.