Injuries associated with

anesthesia
DR. Ghaleb Nasrallah
Head OR&AN. Dept.









The 10 most common causes of intra-op.
cardiac arrest attributable to anesthesia

1. Drug overdose or selection error------ 15.3%
2. Serious arrhythmia ---------------------- 13.9%
3. Myocardial infarction, ischaemia ----- 8.8%
4. Inadequate airway management ---- 7.9%
5. High spinal ---------------- ---------------- 7.4%
6. Inadequate vigilance ------------------- 6.9%
7. Massive haemorrhage managed badly 5.1%
8. Overdose of inhaled anaesthetic ------- 2.8%
9. Suffocation, aspiration ------------------- 2.8%
10.Dis/misconnection ----------------------- 2.3%

Factors involved in deaths
attributable in part to anesthesia
failure of a trainee to consult a more senior anesthetist
inadequate monitoring
inappropriate drug doses
poor standard of practice
Failure to apply knowledge
Lack of care
Failure of organization
Lack of experience
Lack of knowledge
Drug effect
Failure of equipment
Fatigue

The most commonly quoted critical incidents
in the Australian Incident Monitoring Study

Problems with breathing system
Disconnections
Misconnections
Leaks

Problems in administration of drugs
Overdosage
Underdosage
Wrong drug
The most commonly quoted critical incidents in
the Australian Incident Monitoring Study cont.
Problems with intubation and control of airway
Failed intubation
Oesophageal intubation
Endobronchial intubation
Accidental or premature extubation
Aspiration

Failure of equipment
Laryngoscopes
Intravenous infusion devices
Breathing system valves
Monitoring devices

Human errors
Wrong drug administration -----------------24%
Misuse of anesthetic machine--------------22%
Problem with airway management--------16%
Problem with breathing system-------------11%
Fluids therapy mismanagement-------------5%
IV. Therapy disconnection---------------------6%
Failure of monitoring----------------------------4%
Others-----------------------------------------------12%
Mismatched blood.,n2o or co2 instead of o2 .

Examples of the commonest factors associated
with critical incidents in the Australian Incident
Monitoring Study

Inattention/carelessness
Inexperience
Haste
Failure to check equipment
Unfamiliarity with equipment
Poor communication
Restricted visual field or access
Failure of planning
Distraction
Lack of skilled assistance
Lack of supervision
Fatigue and decreased vigilance

Most common complications found on analysis of
1784 American closed claims related to anesthetic
care in the 1990s

1. Death ----------------------------------- 23%
2. Nerve injury --------------------------- 21%
3. Brain damage ------------------------- 9%
4. Burns/skin inflammation ----------- 6%
5. Awareness ------------------------------ 5%
6. Eye injury -------------------------------- 5%
7. Backache--------------------------------- 5%
8. Headache -------------------------------- 5%
9. Pneumothorax ------------------------- 4%
10. Aspiration pneumonitis--------------- 3%
11. Injury to newborn ---------------------- 1.5%

Important complications of GA

pain
Nausea and vomiting - up to 30% of patients
Damage to teeth - 1 in 4,500 cases
Sore throat and laryngeal damage
Anaphylaxis to anaesthetic agents - figures such as 0.2%
have been quoted
Cardiovascular collapse
Respiratory depression
Aspiration pneumonitis - up to 4.5% frequency has been
reported; higher in children
Hypothermia

Important complications of GA cont.

Hypoxic brain damage
Nerve injury 0.4% in GA and 0.1% in RA
Awareness - up to 0.2% higher in obst & cardiac pts.
Embolism - air, thrombus, venous or arterial
Backache
Headache
Idiosyncratic reactions related to specific agents - eg,
MH with suxa, succinylcholine-related apnea
Iatrogenic - eg, pneumothorax related to C.L.insertion
Death


Important complications of RA

Pain - 25% of patients still experience pain despite spinal
anaesthesia
Post-dural headache from cerebrospinal fluid (CSF) leak
Hypotension & bradycardia through blockade of the
sympathetic nervous syst.
Limb damage from sensory and motor block
Epidural or intrathecal bleed
Respiratory failure if block is 'too high'
Direct nerve damage


Important complications of RA CONT.

Hypothermia
Damage to the spinal cord - transient or permanent
Spinal infection
Aseptic meningitis
Haematoma of the spinal cord - enhanced by use of
LMWH pre-operatively
Anaphylaxis
Urinary retention
Spinal cord infarction
Anesthetic intoxication


Important complications of LA

Pain.
Bleeding and haematoma formation.
Nerve injury due to direct injury.
Infection.
Ischaemic necrosis.

Where Safety Starts ?
Patient
Facilities, Equipment, and Medications Anaesthetists Skill

Surgeons Skill
Anesthetist Skill

Learn one or two alternate method of
Airway skill
Practice it in routine cases
Facilities and Equipments

Macintosh
Magill
Miller
Polio
Mc Coy
(GEB)
Endotracheal Tube Introducer
(LMA )
Airways
Igel
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D
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A
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Conclusions
The safety of patients does not depend solely on
the application of standards of practice,
the purchase of new equipment
and the institution of new monitoring techniques.

Safety can be increased only by
Combining the use of modern technology
with improvements in
Education, Training, Supervision, Attitudes,
Standards of clinical practice, Audit and Vigilance
Reference
http://www.patient.co.uk/doctor/important-
complications-of-anaesthesia
British Journal of Anaesthesia 95 (1): 95109 (2005)
doi:10.1093/bja/aei132 Advance Access publication
May 20, 2005
University Department of Anaesthesia, The University
of Nottingham, Queens Medical Centre,
Nottingham NG7 2UH, UK
*E-mail: Alan.Aitkenhead@nottingham.ac.uk