Chapter 46

• Complications related to the delivery of anesthesia care are inevitable. Even the most experienced, diligent, and careful practitioners will have to manage complications despite acting well within the standard of care.
• Anesthetic mishaps can be categorized as preventable or unpreventable. Of the preventable incidents, most involve human error, as opposed to equipment malfunctions.
• Death and permanent neurological damage were just as often associated with adverse cardiovascular as adverse respiratory events. A reduction in adverse respiratory events was believed to be due to widespread adoption of pulse oximetry and capnography as standard monitors.
• Many anesthetic fatalities occur only after a series of coincidental circumstances, misjudgments, and technical errors (mishap chain).
• Although the mechanisms differ, anaphylactic and anaphylactoid reactions can be clinically indistinguishable and equally life-threatening. Cardiovascular and cutaneous manifestations are more common features of anaphylaxis than bronchospasm during anesthesia.
• True anaphylaxis due to anesthetic agents is rare; anaphylactoid reactions are much more common. Muscle relaxants have emerged as the most common cause of anaphylaxis during anesthesia. Latex allergy is the second most common.
• Patients with spina bifida, spinal cord injury, and congenital abnormalities of the genitourinary tract have a very high incidence of latex allergy.
• Although there is no clear evidence that exposure to trace amounts of anesthetic agents presents a health hazard to operating room personnel, the U.S. Occupational Health and Safety Administration continues to set maximum acceptable trace concentrations of less than 25 ppm for nitrous oxide and 0.5 ppm for halogenated anesthetics (2 ppm if the halogenated agent is used alone).
• Hollow (hypodermic) needles pose a greater risk than solid (surgical) needles because of the potentially larger inoculum. The use of gloves, needleless systems, or protected needle devices may decrease the incidence of some (but not all) types of injury.
• Anesthesiology is a high-risk medical specialty for drug addiction.
• The two most important methods of minimizing radiation exposure are using proper barriers and maximizing one’s distance from the source of radiation.

Complications related to the delivery of anesthesia care are inevitable. Even the most experienced, diligent, and careful practitioners will have to manage complications despite acting well within the standard of care. These complications will range from minor (eg, infiltrated intravenous line) to catastrophic (hypoxic brain injury or death).

When complications do occur, appropriate evaluation, management, and documentation are critical in minimizing or eliminating negative outcomes. A good example is the unanticipated difficult airway. Although a comprehensive preanesthetic airway evaluation will help the clinician anticipate and prepare for most difficult intubations, it will still fail to predict problems in a few patients who cannot be intubated except by specialized techniques (see Chapter 6). In these cases, despite preoxygenation and cricoid pressure (if appropriate), the risk of aspiration, airway obstruction, and hypoxia is high and extraordinary measures to secure the airway (cricothyrotomy or surgical tracheostomy) may become necessary. Although establishing a surgical airway is a lifesaving procedure, it will inevitably be considered a “complication.” Also, the patient will require ...

Sign in to your MyAccess profile while you are actively authenticated on this site via your institution (you will be able to verify this by looking at the top right corner of the screen - if you see your institution's name, you are authenticated). Once logged in to your MyAccess profile, you will be able to access your institution's subscription for 90 days from any location. You must be logged in while authenticated at least once every 90 days to maintain this remote access.

Ok

## Subscription Options

### AccessAnesthesiology Full Site: One-Year Subscription

Connect to the full suite of AccessAnesthesiology content and resources including procedural videos, interactive self-assessment, real-life cases, 20+ textbooks, and more