Anesthesia Related Hazards / Risks

Anesthesia Related Hazards / Risks

Risk

Is the potential that a chosen action or activity (including the choice of inaction) will lead to a loss or an undesirable outcome. The notion implies that a choice having an influence on the outcome exists (or existed). Risk is a ubiquitous, natural part of life, because everything we do, including doing nothing, poses an uncertain outcome. In common usage, anesthesia risk connotes an undesirable or negative occurrence, such as death or injury. We occasionally use the term to refer to the outcome itself (e.g., death as one risk of anesthesia). A detailed analysis of the many possible anesthesia-associated adverse out-comes is beyond the scope of this chapter.

Anesthesia Risk and Accidents

Accident is an unplanned, unexpected, and undesired event, usually with an adverse consequence. There is a general belief that the risk of preventable death or injury from anesthesia is relatively low compared to many other medical and nonmedical risks. Yet, there are no accurate estimates of the rate of adverse out-come in general or for an individual patient presenting with specific risk factors. One reason is that there are no standard methods for assigning causality appropriately among numerous factors that include anesthesia, surgery, the facility (and its systems), and the patient's disease. Some specific hazards associated with anesthesia include errors related to airway management, monitoring, and sudden cardiac arrest during spinal anesthesia, equipment failures, or nerve injuries.

Events associated with management of respiration are the most serious hazards in anesthesia. The three most common causes of death and brain damage are inadequate ventilation, esophageal intubation, and difficult tracheal intubation. The large majority of cases in the first 2 causes were judged to have been preventable if better monitoring had been employed. Anticipated difficult tracheal intubation shall be referred to better institution or surgical air way should be performed before anesthesia.

Failure to monitor the patient adequately is an important contributor to anesthesia adverse events. There are numerous ways in which pulse oximetry, capnometry, and automated blood pressure monitors can give false information, leading to missed or incorrect diagnoses.

Medication errors are among the most frequent errors in anesthesia, and in healthcare practice in general. Similarity of drug names, containers, and label colors contribute to the ease by which such errors can be made, especially during periods of high stress. Dosing errors are also common and related to the frequent need for individual numerical calculations when drawing and mixing drugs for bolus administration or intravenous infusion. Choosing the wrong form of drug (e.g., among various insulin formulations), flushing a catheter with a solution containing another potent drug, and confusion in the programming of infusion pumps are other examples of ways in which patients can be injured. An obvious recommendation for prevention of some medication errors is to read the label carefully 3 times.

Error is when a planned sequence of mental or physical activities fails to achieve its intended outcome and these failures cannot be attributed to the intervention of some chance agency. Diagnostic errors occur, especially during the management of critical events.

Current anesthesia machines and associated technology incorporate substantial safety features. Equipment failure is frequent and can occur in many ways, but rarely causes injury directly. Equipment associated injury; it is more likely to be from misuse than from overt failure of a device.

Errors Associated with a lack of standard practice and unusual situations: The complexities of anesthesia create many opportunities for preventable adverse events caused by unusual circumstances or pitfalls such as:

• An emergency can arise during transport of the intubated patient if the tracheal tube is accidentally dislodged.
• Administration of undiluted phenytoin (Dilantin) by rapid intravenous infusion can cause refractory hypotension, arrhythmias, and death.
• Administration of undiluted potassium by rapid intravenous infusion can cause ventricular fibrillation and cardiac arrest.
• Neostigmine given without an antimuscarinic drug (e.g., atropine or glycopyrrolate) can cause asystole/severe bradycardia and atrioventricular (AV) block, and can be fatal.
• Inadvertent intravascular injection of local anesthetics during a nerve block can cause neurologic and cardiac toxicity, which can be fatal (especially with bupivacaine).
• Air embolism can occur during the placement or removal of central venous catheter
• Limb necrosis can develop if the tourniquet used for intravenous placement or blood draw is left on the anesthetized patient for a prolonged period