RT Book, Section
A1 Butterworth, John F.
A1 Mackey, David C.
A1 Wasnick, John D.
SR Print(0)
ID 57239722
T1 Chapter 54. Anesthetic Complications
T2 Morgan & Mikhail's Clinical Anesthesiology, 5e
YR 2013
FD 2013
PB The McGraw-Hill Companies
PP New York, NY
SN 978-0-07-162703-0
LK accessanesthesiology.mhmedical.com/content.aspx?aid=57239722
RD 2021/02/25
AB The  rate  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  coincide  (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.  Muscle  relaxants  are  the  most  common  cause  of  anaphylaxis  during  anesthesia.  Patients  with  spina  bifida,  spinal  cord  injury,  and  congenital  abnormalities  of  the  genitourinary  tract  have  a  very  increased  incidence  of  latex  allergy.  The  incidence  of  latex  anaphylaxis  in  children  is  estimated  to  be  1  in  10,000.  Although  there  is  no  clear  evidence  that  exposure  to  trace  amounts  of  anesthetic  agents  presents  a  health  hazard  to  operating  room  personnel,  the  United  States  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.