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Basics of Anesthesia > Week 10 - Anesthesia Complications > Flashcards

Week 10 - Anesthesia Complications Flashcards

1
Q

What are the most common events leading to injury in anesthesia claims?

A
  • Regional blocks (20%)
  • Respiratory problems (17%)
  • Cardiovascular events (13%)
  • Equipment problems (10%)
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2
Q

What is the definition of minor anesthesia morbidity?

A

Moderate distress without prolongation of hospital stay without permanent sequelae

  • mild PONV, hoarse voice
  • Incidence may be as high as 50%
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3
Q

What is the definition of intermediate anesthesia morbidity?

A

Serious distress or prolongation of stay without permanent sequelae

-dental injury, severe PONV, peripheral nerve injury that resolves

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4
Q

What is the definition of major anesthesia morbidity?

A

Permanent disability and sequelae

-spinal cord injury

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5
Q

What is the most common cardiovascular complication following non-cardiac surgery?

A

Myocardial Infarction

-5% in patients over 45 with CV risk factors

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6
Q

What are independent predictors of perioperative MI?

A
  • Every 10 beat/min increase in baseline HR
  • History of stroke
  • Undergoing major vascular surgery
  • Preoperative serum creatinine level greater than 2.0 mg/dL
  • Age per decile increase
  • Emergency or urgent surgery
  • Serious bleeding (2 units or more)
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7
Q

What is the most common cause of perioperative pediatric cardiac arrest?

A

Hypovolemia

-related to underestimation of blood loss and inadequate IV access

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8
Q

What are common postop pulmonary complications?

A
  • Laryngospasm
  • Bronchospasm
  • Airway obstruction
  • Desaturation
  • Pneumonia
  • PE
  • Aspiration pneumonia
  • Reintubation/mechanical intubation without identifiable cause
  • Severe coughing
  • Stridor
  • Pleural effusion
  • Pneumothorax
  • Respiratory infection
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9
Q

What are neurologic complications of anesthesia?

A

Postop Cognitive Dysfunction: delirium, dementia, confusion, learning and memory problems

Peripheral or Spinal nerve injury

Visual loss

CVA

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10
Q

What are the predisposing co-morbidities that increase the risk for perioperative stroke?

A
  • Age
  • History of ARF or dialysis
  • TIA or stroke
  • Female
  • Cardiac disease
  • Hypertension
  • Current tobacco use
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11
Q

What are perioperative events that increase the risk of perioperative stroke?

A
  • Anti platelet cessation
  • Statin cessation
  • Dysrhythmia
  • Hypotension
  • Anemia
  • Dehydration
  • Hypercoagulable state
  • MI or CHF
  • Beta blocker initiation
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12
Q

What procedures are high risk for perioperative stroke?

A
  • Carotid surgery
  • Cardiopulmonary bypass
  • Open heart (valve replacement)
  • Aortic arch
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13
Q

What is spinal cord ischemia in thoracoabdominal aortic surgery caused by?

A

Imbalance of oxygen demand and oxygen delivery produced by aortic occlusion

Clamp Aorta –> decreased arterial flow/increased CVP and SFP –> decreased cord perfusion –> O2 supply is less than demand –> ischemia

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14
Q

What are situations posing increased unintended awareness risk?

A
  • Unsafe to administer sufficient anesthesia
  • Mistake/failure in anesthesia delivery
  • Anesthetic technique results in inadequate anesthesia
  • Patient needs are underappreciated
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15
Q

What is the purpose of the Michigan Awareness Classification Instrument?

A
  1. Allow at least nominal statistical analysis on the qualitative aspects of awareness reports
  2. Facilitate the study of more subtle effects of interventions to prevent awareness
  3. Aid in the prediction of post awareness sequelae such as PTSD

*Class 0: No awareness up to Class 5: Paralysis and pain

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16
Q

What should you ask a patient to assess for awareness?

A
  • What was the last thing you remember before going to sleep?
  • What is the first thing you remember after waking up?
  • Do you remember anything between going to sleep and waking up?
  • Did you dream during your procedure?
  • What was the worst thing about your operation?
17
Q

What should you do if a patient reports awareness?

A
  • Contact the healthcare professionals who directly cared for the pt
  • Document an accurate and detailed pt account
  • Refer pt to a mental health professional
  • Conduct a root cause analysis to identify the causative factors
  • Assess for and document anesthesia awareness events for QI processes
  • Conduct daily visits with the pt until discharge
  • Confirm whether appropriate follow up care is necessary
18
Q

What are the top five variables associated with 30 day mortality after non cardiac surgery in patients over 80?

A
  1. ASA physical status
  2. Preoperative plasma albumin concentration
  3. Emergency surgery
  4. Perop functional status
  5. Preop renal impairment
19
Q

What are the domains of measurement of frailty?

A
  • Unintentional weigh loss greater than 4kg in the past year
  • Exhaustion measured by assessing effort and motivation
  • Decreased grip strength
  • Slowed walking speed
  • Low physical activity
  • 2-3 domains have intermediate frailty
  • 4-5 domains are classified as frail
20
Q

What is a major contributing factor in anesthesia morbidity and mortality?

A

Suboptimal care related to inadequate patient evaluation or incorrect preop management

21
Q

Human error has been identified in what percent of anesthesia related deaths?

A

51-77%

22
Q

What is the swiss cheese model of systems failure?

A

Each layer in the system is described as a defense system that has potential for errors (the holes)

The ideal system is like a stack of swiss cheese where the holes don’t align – an error occurs when the systems defense system fails

  • some holes are active errors (occur at the point of contact to the patient)
  • some holes are latent errors (accidents waiting to happen due to design failure or organizational failures)
23
Q

What is TeamSTEPPS?

A

evidence-based teamwork system aimed at optimizing patient outcomes by improving communication and teamwork skills among health care professionals

24
Q

What is situation monitoring and situation awareness?

A

Situation monitoring is the process of continually scanning and assessing a situation to gain and maintain an understanding of what’s going on around you

Situation awareness is the state of “knowing what’s going on around you”

25
Q

What is the second victim effect?

A

Every healthcare provider who experiences harm to or loss of the patient (the first victim) feels devastated and singled out, agonizes and perseverates over the event, hesitates about having discussions with colleagues, questions his or her competence even after years of training and experience, questions potential punishment and job security, fears the patient’s anger and the family’s scorn, laments about apologizing to the patient and family, and continues to feel tormented

Basics of Anesthesia (35 decks)

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