- 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
- 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
- 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 ...