4. ANESTHETIC DEATH
“Anaesthetic death” is often
defined as the death of a patient
who has had an anaesthetic,
within 24 hours of the procedure.
This is irrespective of the
contribution of anaesthesia to the
cause of death.
4
5. The recent studies defined
mortality associated with
anesthesia as a death under
anesthesia or as a result of
anesthesia and death within
24hrs of an anesthetic procedure.
5
8. Can be classified further
into 4 groups according
to the cause of the death
Journal of clinical pathology 1999 52 640-652
Roger. D. Start et al
8
9. Directly caused by the disease for which
anesthesia was being performed eg:
aneurysmal rupture during aneurysmal repair
Caused by a disease other than for which
anesthesia was being performed eg: CAD
patient dying in a whipples resection
Resulting from a mishap of the surgery eg:
rebleeding in Tonsillar surgeries
Resulting from a mishap of anesthesia eg:
slipped ETT in cleft lip and palate surgery
9
10. Incidence
High in the developing countries
High with emergency and complex surgeries
High with age
High with inadequate preop preparation
Inappropriate postop care
Lack of supervision
10
11. Timing of perioperative mortality
Majority occurs in the postoperative(51%)
Intraoperative(37%)and during induction(9%) of
anesthesia
11
Percentage
Postoperative
Intraoperative
Induction
27. 1. Drug overdose/ adverse reaction
2. Rhythm disturbances
3. Peri-op MI
4. Airway obstruction
5. High spinal
6. Lack of vigilance
7. Bleeding
8. Over-dosage of inhalation agent
9. Aspiration
10. Technical problem in anaesthesia system
10 common causes of cardiac
arrest under anaesthesia
29. 1. Preoperative assessment, investigation and counselling
of the patient
2. Preoperative checking of equipment and the assurance
of backup equipment
3. The availability of an appropriately trained Assistant
4. Preoperative consultation with more experienced
personnel, where necessary, regarding the Most
appropriate anaesthetic technique
5. The use of appropriate monitoring techniques
AVOIDANCE OF COMPLICATIONS
31. RECORD KEEPING
Vital sign & treatment
Trends in vital sign
Early intervension
safer sharing of care between
anesthetists
Handover long cases
Better team work
After the event investigations &
learning,thus reducing
complications
31
32. REDUNDENT SYSTEMS
Availability of at least two working
laryngoscopes
Maintenance of 2 or more IV line if
blood loss expected
Monitoring of expired volatile agent
conc . Alongwith depth of anesthesia
monitors
Minimizes risk of awareness
32
33. MONITORING
ASA & AAGBI have set minimum
standard of intraoperative
monitoring
Automatically activated alarm….
Values set by anesthetists
33
34. SUMMARY
Prophylactic measures
Improve the preoperative assessment
Provide preoperative preparations
Improve the monitoring standards
Provide balanced anesthesia
Provide adequate post operative care
Provide adequate supervision
Proper auditing of critical incidents
34
38. GENERAL
MANAGEMENT
Provision of high FiO2
Assurance of adequate cardiac output
Cessation of perfusion …more rapid
damage of organs than low level of
oxygenation
Brain & heart most sensitive
Liver & kidneys …potentially at risk
38
40. 4. Choice of a
working diagnosis,
which is either the
most likely or the most
dangerous possibility
5. Treatment of
the working
diagnosis
6. Assessment of the
response of the
problem to the
treatment
administered
40
41. 7. Refinement of the list
of differential diagnoses,
especially if the response
has not been as expected
8. Confirmation or elimination of
the choice of working diagnosis; if
the response to treatment has
been unexpected then
replacement with a more likely
working diagnosis is indicated
9. Go to step 5 and
repeat until the problem is
resolved
42. RECORD KEEPING &
DOCUMENTATION
Trends in pt physiological data apparent only
when charted
Generation of new DD of a problem with help
of data
Data of an incident & complication important in
preventing future repetition through education
in department
Detailed record available to defend the
practitioner
42
43. Put every moment in
black and white
The more detail, the better
43
44. Documentations after the
event
Prepare the accurate records
Don’t alter the original notes
Amendments and additions are recorded
separately
Preoperative visit details are included
Consent form and relevant investigation
reports are collected
44
45. Documentation checklist
When the patient was first seen by whom?
What was prescribed?
Investigation reports
Plan of anesthesia
Critical incidents
Remedial measures
Senior Help sought
45
49. Communicating with
relatives
Quiet comfortable room to sit
Help from a senior
Surgical and nursing colleague are
included
Explain the serious complications
Tried remedial measures detailed
Answer all immediate questions
49