Anesthesia-related complications:
Gespeichert in:
| Format: | Buch |
|---|---|
| Sprache: | English |
| Veröffentlicht: |
Philadelphia [u.a.]
Saunders
2002
|
| Schriftenreihe: | Anesthesiology clinics of North America
20,3 |
| Schlagworte: | |
| Online-Zugang: | Inhaltsverzeichnis |
| Beschreibung: | XIV S., S. 247 - 494 Ill., graph. Darst. |
Internformat
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Datensatz im Suchindex
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| adam_text | AM M1 Il SIA KI I Al I L lOMPl R. AI IONS
CONTENTS
Preface xii
Stanley Weber
The Closed Claims Project: Has it Influenced Anesthetic
Practice and Outcome? 485
Lorri A. Lee and Karen B. Domino
The Closed Claims Project was established by the American
Society of Anesthesiologists to identify anesthetic related com¬
plications and their mechanism of occurrence with the goal of
improving patient safety. Although the Closed Claims Project
has inherent biases, it has provided information that has influ¬
enced the standards for the practice of anesthesia and stimulated
research in problem areas. The decrease in severity of injury in
anesthesia malpractice claims over the last 3 decades suggests
that anesthesia safety improved during the 1990s.
Traumatic Complications of Airway Management 503
Stanley Weber
Safe and effective airway management techniques have become
a hallmark of modern anesthesiology practice, but even such
overwhelmingly successful and life saving practices come with
a cost. This cost is morbidity and mortality secondary to the
techniques themselves. Closed claims analysis has shown that
adverse outcomes secondary to respiratory events constitute the
single largest source of injury to patients (75%). Airway man¬
agement complications are a significant subset of these out¬
comes. Difficult intubation was shown to be a factor in only
slightly more that one third (38%) of these claims. Six percent o
closed claims were for airway trauma. These data indicate that
injury frequently occurs without initial difficulty in management
of the airway, may occur throughout the perioperative period
and can be unexpected when it occurs. Thorough knowledge of
VOLUME 20 • NUMBER 3 • SEPTEMBER 2002 v
the mechanisms of airway injury associated with different air¬
way management techniques may allow for better patient out¬
comes. This chapter reviews complications of airway manage¬
ment involving the placement of endotracheal tubes. In addition,
because laryngeal mask airways (LMAs) have gained increasing
prominence in airway management use in the past 10 years,
complications relating to their use will also be reviewed.
Respiratory Complications Associated with Anesthesia 513
Charles B. Watson
Perioperative pulmonary morbidity is a significant anesthesia
problem despite recent technical advances and safer anesthetic
drugs. Anesthesia related perioperative pulmonary complica¬
tions (PPCs) are often multifactorial. They are associated with
underlying cardiopulmonary disease, well characterized physi¬
cal impact of the surgical procedure, mechanical and neuromus
cular effects of anesthetic drugs and procedures, unexpected
toxic/metabolic reactions, and combined effects of several of
these factors. Specific goal directed, preanesthetic preparation
reduces PPC rates of patients with chronic cardiopulmonary dis¬
ease and of those who undergo high risk or problem prone pro¬
cedures. Postanesthetic pain management probably reduces pul¬
monary complications, though data are conflicting and it is dif¬
ficult to draw conclusions from the incomparable anesthetic
approaches/techniques and patient populations studied in the
perioperative literature. Although some PPCs are unexpected,
the integration of preoperative evaluation and preparation with
a well formulated anesthetic care plan and a post anesthetic
recovery plan for high risk patients and those who undergo
high risk procedures minimizes adverse PPCs. The anesthesiol¬
ogist who understands the impact of anesthetic and surgical
interventions is the medical specialist who is best equipped to
plan and coordinate treatment for anticipated or unpredicted
problems. Anesthesia providers can implement strategies that
limit or manage pulmonary morbidity and reduce costly special
care and hospital length of stay.
Complications of Inhaled Anesthesia Delivery Systems 539
Russell C. Brockwell and J. Jeff Andrews
Inhaled anesthesia delivery systems (ADS) have evolved in the
past 20 years from simple pneumatic machines to complex
computer controlled devices. For the purposes of this discus¬
sion, we will outline some of the potential complications that
may result from the use of these systems. Because of the com¬
plexity of modern ADS, it is incumbent on the anesthesiologist to
be cognizant of potential problems that may arise with their use.
Even though it is now more difficult than ever for the practi¬
tioner to develop a comprehensive understanding of these
TONTENTS
machines, it remains essential for the safe practice of anesthesia.
When the anesthesiologist understands the basic design differ¬
ences between products from different manufacturers, it is more
likely that the appropriate preoperative checks will be performed
and that delivery of a safe anesthetic can be ensured. Although
malpractice claims associated with anesthesia delivery systems
are rare, when they do occur they may be severe, and they con¬
tinue to occur. These complications may range in severity from
mild hypercapnia to awareness and even death.
Awareness During Anesthesia 555
Pete H. Spitellie, Megan A. Holmes, and Karen B. Domino
The number of patients who have preoperative anxiety over
possibly waking up in the middle of surgery has increased
dramatically over the last decade. McCleane and Cooper found
that more than 50% of 247 patients were concerned that they
would not be asleep during their surgery. Even after having an
adequate anesthetic, 25% were still worried about being asleep
with future anesthetics. With increased media coverage, these
anxieties are not likely to go away anytime soon. For the patient,
awareness or recall while under general anesthesia is a frighten¬
ing experience that can lead to debilitating emotional injury and
even post traumatic stress disorder. For anesthesiologists, aware¬
ness under anesthesia ranks second only to death as a dreaded
complication. This chapter reviews the incidence, etiology, psy¬
chological sequelae, medicolegal consequences, and prevention
of awareness during anesthesia.
Complications of Invasive Monitoring 571
T. Andrew Bowdle
This chapter discusses the complications of invasive hemody
namic monitoring, which are defined here as central venous
pressure (CVP), pulmonary artery (PA), and peripheral arterial
catheters. The perspective is that of the anesthesiologist
performing these procedures in the operating room or intensive
care unit. Accordingly, chronic venous catheterization, which is
usually performed by a surgeon, is not specifically addressed.
Many possible complications may result from any invasive medi¬
cal procedure, though they occur rarely. This chapter emphasizes
the most common and most clinically significant problems and
some methods for avoidance and treatment. It is not intended to
be an exhaustive catalogue of every reported complication.
Ulnar Nerve Injury and Perioperative Arm Positioning 589
Richard C. Prielipp, Robert C. Morell, and John Butterworth
Primum non nocere. Hippocrates included this admonition in
Epidemics, Book 1, Second Constitution, to do good or to do no
CONTENTS vii
harm. However, even the most conscientious health care
provider will encounter unexpected and serious adverse medical
events. This discussion focuses on one relatively common, often
perplexing, and usually unexplained perioperative complica¬
tion: ulnar neuropathy. Perioperative ulnar neuropathy has
received increased scientific attention because it accounts for one
third of all nerve injury claims in the American Society of
Anesthesiologists (ASA) Closed Claims Study database. In addi¬
tion, these injuries may result in chronic pain or paresthesia,
employment disability, catastrophic economic damages, and
malpractice litigation. We will explore the current understanding
of perioperative ulnar nerve dysfunction by summarizing the
relevant scientific literature and information within the ASA
closed claims database, describing the epidemiologic features of
perioperative nerve injuries, discussing relevant clinical investi¬
gations and recommendations for safe arm positioning during
anesthesia, and reviewing the medico legal issues inevitably
intertwined with this topic, particularly the doctrine of res
ipsa loquitur.
Postoperative Blindness 605
E. Lynne Williams
This chapter discusses the cases of postoperative blindness
reported in the literature and the theories that attempt to explain
the mechanisms involved. Although uncommon, alterations in
vision and blindness after anesthesia for major surgical proce¬
dures, particularly cardiopulmonary bypass or spine surgery, are
well documented, with an incidence varying between 0.05% and
1%. Accurate incidence data are unavailable because it is not
known what percentages are reported. However, the large num¬
ber of case reports over many years has provided some signifi¬
cant information. Although sustained compression of the eye is
an important cause, postoperative visual loss may also occur, in
an unrelated manner, because of ischemic optic neuropathy,
central retinal artery or vein occlusion, or cortical blindness.
Malignant Hyperthermia and Myotonic Disorders 623
Harvey K. Rosenbaum and Jordan D. Miller
Malignant hyperthermia (MH) is a rare, potentially lethal disor¬
der of skeletal muscle. MH susceptible persons may acquire ful¬
minant hypermetabolism and muscle injury when administered
potent inhalational anesthetics or succinylcholine. In the past,
MH was referred to as a hidden killer. Why hidden? MH is
rare and unexpected unless there is a personal or family history
of an MH episode. Although MH susceptibility is usually inher¬
ited as an autosomal dominant trait, the pre anesthetic family
history is often negative. Patients with MH susceptibility usual¬
ly have no symptoms of musculoskeletal disease or objective
weakness. Lastly, the patient may have an episode of MH despite
viii CONTENTS
an uneventful history of general anesthetics, even those includ¬
ing triggering agents.
Complications of Regional Anesthesia: An Overview 665
Bruce Ben David
Perhaps the clearest picture of the numbers and types of injuries
from regional anesthesia is provided by the ASA Closed Claims
Project database. In reviewing these data, it is valuable to keep
in mind, of course, that the lack of a denominator makes the cal¬
culation of incidence impossible. For the decade of the 1990s, 308
claims were associated with regional anesthesia (versus 642
claims associated with general anesthesia). The percentage of
these claims for patient death (10%) continued its steady decline
from more than 20% in the 1970s and 13% in the 1980s. The pri¬
mary reason for death remains cardiac arrest associated with
neuraxial blockade, though this now represents only 30% of the
deaths as opposed to 61% in the 1970s and 40% in the 1980s.
There were 71 permanent disabling injuries among the 308
claims. The most common of these (23%) was associated with
nerve blocks of the eye (13 retrobulbar, 3 peribulbar), and typi¬
cally the injury entailed loss of vision. Second in frequency (21%)
were pain management related claims involving, for example,
neuraxial opiates or neurolytic blocks. Third in frequency (20%)
were nerve injuries associated with neuraxial and peripheral
blocks followed by epidural hematomas (13%).
Complications of Neuraxial Blockade 669
Bruce Ben David and Randy Rawa
Epidural and spinal anesthesia enjoy wide usage in modern
practice, and each can provide reliable and safe anesthesia.
Although the techniques appear to the casual observer to require
relatively straightforward technical skill, both are fraught with
myriad hazards and potential complications. It is the familiarity
with and the understanding of these complications that makes
for safe and professional practice of these techniques.
Complications of Peripheral Blockade 695
Bruce Ben David
This chapter presents a framework in which to consider the
many possible complications of the broad array of peripheral
regional anesthesia techniques. The basis of that framework is an
organization of those complications into four simple categories:
psychogenic reactions, coincident complications, trauma from
the technique, and untoward effects of the local anesthetic and
adjuvant drugs. The two former categories are discussed in the
overview. This chapter considers the latter two categories.
CONTENTS ix
£
Postoperative Nausea and Emesis 709
Mehernoor F. Watcha
Watcha and White have made recommendations for antiemetic
therapy and prophylaxis based on published peer reviewed
studies. They range from no prophylaxis for patients at low risk
to multimodal antiemetic therapy for those at the highest risk.
Recommendations for rescue therapy of breakthrough PONV
are also provided. With this approach, it should be possible to
individualize prophylaxis and rescue therapy to achieve an
optimal, cost effective management strategy for this uncomfort¬
able postoperative complication.
Index 723
x CONTENTS
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| title | Anesthesia-related complications |
| title_alt | Anesthesia related complications |
| title_auth | Anesthesia-related complications |
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| title_fullStr | Anesthesia-related complications Stanley Weber guest ed. |
| title_full_unstemmed | Anesthesia-related complications Stanley Weber guest ed. |
| title_short | Anesthesia-related complications |
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| topic | Anesthesia complications Narkosezwischenfall (DE-588)4171165-8 gnd |
| topic_facet | Anesthesia complications Narkosezwischenfall Aufsatzsammlung |
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