Serious intraoperative problems — a five-year review of 83,844 anesthetics

Abstract

P Pu ur rp po os se e: : The low incidence of mortality and major morbidity in anesthesia makes it difficult to study the pattern of potential accidents and to develop preventive strategies. Anesthetic 'near-misses', however, occur more frequently. Using data from a simple routine-based system of problem reporting, we have analyzed the pattern and causes of serious non-fatal problems, in order to improve preventive strategies. M Me et th ho od ds s: :We prospectively recorded anesthesia-related information from all anesthetics for five years. The data included intraoperative problems, which were graded into four levels, according to severity. We analyzed only the serious nonfatal problems, which were sorted according to clinical presentation, and also according to which factor was most important in the development of the problem. We assessed any untoward consequences for the patient, and whether the problems could have been prevented. R Re es su ul lt ts s: : Serious problems were recorded in 315 cases out of 83,844 (0.4%). Anesthesia was considered the major contributing factor in 111 cases. Difficult intubation, difficult emergence from general anesthesia, allergic reactions, arrhythmia and hypotension were the dominating problems. Twenty-six anesthesia related problems resulted in changes in level of postoperative care, and one patient later died in the intensive care unit after anaphylactic shock. Eighty-two problems could have been prevented by simple strategies.C Co on nc cl lu us si io on n: : Analysis of serious nonfatal problems during anesthesia may contribute to improved preventive strategies. Data from a routine-based system are suitable for this type of analysis. Intubation, emergence, arrhythmia, hypotension and anaphylaxis cause most serious problems, and should be the object of preventive strategies. Objectif : La faible incidence de mortalité et de morbidité importante en anesthésie complique l'étude des types d'accidents potentiels et la

Incidence of postintubation hemodynamic instability associated with emergent intubations performed outside the operating room: a systematic review

“…5 Accordingly, the incidence of adverse events associated with EETI is high in comparison with elective endotracheal intubation performed in the operating theatre. [6][7][8][9][10] Adverse events during EETI range from relatively minor (local oropharyngeal soft tissue and dental trauma) to life threatening (dysrhythmias, hypoxia, hemodynamic instability, and cardiac arrest). [11][12][13] Hemodynamic instability in the postintubation phase is a potentially important adverse event associated with EETI that has not been fully described.…”

Le fait de boire 300 mL de liquide clair deux heures avant d’être opéré n’a pas d’effet sur le volume de liquide ni sur le pH gastriques chez des patients obèses à jeun ou non

“…ULMONARY aspiration of gastric contents during general anesthesia is a rare event in healthy patients undergoing elective surgery. [1][2][3] In ASA I and II patients, the incidence is one in 7,000 to 9,000, but increases to one in < 400 in ASA III to V patients undergoing emergency surgery. 2 Overall mortality from pulmonary aspiration is one in 45,000 to 70,000 and occurs almost exclusively in the latter group.…”

“…2 Overall mortality from pulmonary aspiration is one in 45,000 to 70,000 and occurs almost exclusively in the latter group. [1][2][3] In 1999 a task force of the ASA, after an exhaustive review of randomized clinical trials and other scientific evidence, recommended that healthy patients undergoing elective surgery could safely drink clear liquids until two hours preoperatively and that routine pharmacologic antacid prophylaxis was not indicated. 4 The task force cautioned that the guidelines may need to be modified for patients with co-existing disease that might affect gastric emptying or fluid volume (e.g., pregnancy, obesity, diabetes, hiatal hernia, gastroesophageal reflux disease, ileus or bowel obstruction, emergency care or enteral tube feeding) and patients in whom airway management might be difficult.…”

L’incidence de l’hypotension post-intubation endotrachéale chez des patients en salle de réanimation: impact des définitions

“…5 Cependant, il est rapporté que, lorsque comparé à des méthodes de ventilation non-invasives, l'IET est associée à davantage d'évènements indésirables. [6][7][8] Ces effets indésirables peuvent être de nature mineure ou majeure, allant du trauma dentaire aux altérations hémodynamiques telles que la bradycardie, l'hypotension ou même l'arrêt cardio-respiratoire. Le décès est aussi un évènement redouté pouvant survenir.…”