Closed claims review of anesthesia for procedures outside the operating room

Abstract

Nonoperating-room anesthesia claims had a higher severity of injury and more substandard care than operating room claims. Inadequate oxygenation/ventilation was the most common mechanism of injury. Maintenance of minimum monitoring standards and airway management training is required for staff involved in patient sedation.

Use of the gastro-laryngeal tube in endoscopic retrograde cholangiopancreatography cases under sedation/analgesia

“…(5). For this reason, it is recommended to conduct the intervention with hemodynamic data monitoring and under deep sedation or general anesthetic (8,9). …”

Multidisciplinary guidelines for the management of tracheostomy and laryngectomy airway emergencies

“…This is due to numerous factors including a reduction in the number of difficult airways that present late, shorter working hours, better airway equipment, increased use of supraglottic airways and a reduction in training opportunities [54,59,[128][129][130][131][132][133][134]. It is essential that frontline medical, nursing and allied health staff are competent to manage and assist with tracheostomy and other related airway emergencies if they work in a relevant clinical area [31,38,53,[135][136][137][138][139][140].…”

Changing Trends in Dental Procedural Sedation

“…Complications in procedural sedation can be varies from mild difficulties to fatal one. (Table 2) Incidence of complications may be higher in non-operative room sedation than operative room [16] . When procedure sedation is conducted by non-anesthesiologist outside operative room, incidence of complications may not be different, but the rate of death and failure-to-rescue were greater when caring was not directed by anesthesiologists, demonstrating that 30-day morbidity and mortality were lower when anesthesiologists directed anesthesia care [17] .…”

“…Basic monitoring should be of same standard basic monitoring as in OT. Close claims frequently judged as substandard monitoring [16] . Physician providing sedation must be skilled and proficient in airway management and cardiovascular support and must be skillful to rescue patient from sedation deeper than intended.…”

“…Midazolam can be administered by various route including oral, nasal, buccal, transmucosal, intramuscular and intravenous ones. Midazolam can potentiate the respiratory depression action of opioid or other respiratory depressant [2,16] .…”