Chapter 54: Anesthetic Complications

KEY CONCEPTS

• The likelihood of anesthetic complications will never be zero. All anesthesia practitioners, irrespective of their experience, abilities, diligence, and best intentions, will participate in anesthetics that are associated with patient injury.

• Malpractice occurs when four requirements have been met: (1) the practitioner must have a duty to the patient; (2) there must have been a breach of duty (deviation from the standard of care); (3) the patient (plaintiff) must have suffered an injury; and (4) the proximate cause of the injury must have been the practitioner’s deviation from 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.

• The relative decrease in death attributed to respiratory rather than cardiovascular damaging events has been attributed to the increased use of pulse oximetry and capnometry.

• Many anesthetic fatalities occur only after a series of coincidental circumstances, misjudgments, and technical errors combine (mishap chain).

• Despite differing mechanisms, anaphylactic and anaphylactoid reactions are typically clinically indistinguishable and equally life threatening.

• True anaphylaxis due to anesthetic agents is rare; anaphylactoid reactions are much more common.

• Patients with spina bifida, spinal cord injury, and congenital abnormalities of the genitourinary tract have a markedly increased incidence of latex allergy. The incidence of latex anaphylaxis in children is estimated to be 1 in 10,000.

• There is no clear evidence that exposure to trace amounts of anesthetic agents presents a health hazard to operating room personnel; however, 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 do 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 substance abuse.

• The three most important methods of minimizing radiation doses are limiting total exposure time during procedures, using proper barriers, and maximizing one’s distance from the source of radiation.