Critical incidents anaesthesia

1. CRITICAL INCIDENTS IN
ANAESTHESIA
DR. UBA

2. Outline
• Introduction
• History
• Importance of critical incident reporting
• Risk factors
• Critical incidents in anaesthesia
• Prevention
• Conclusion

3. Introduction
• A critical incident is any preventable mishap
associated with the administration of
anaesthesia and which leads to or could have
led to an undesirable patients’ outcome.
• Never events are defined as serious, largely
preventable patient safety incidents that
should not occur if relevant preventive
measures have been put in place.

4. History
• Critical incident investigation was first used
among military pilots aiming to improve their
performance and safety
• Anaesthesia was the first department to adopt
critical incident reporting in healthcare

5. Importance of Critical Incident
Reporting
• Studying critical incidents helps formulate
strategies to prevent their recurrence
• To improve anaesthesia care and patient
safety
• For training of theatre staff
• Policy making

6. Risk Factors
• Factors that contribute to critical incidents in
anaesthesia could be patient-related, surgery-
related or anaesthesia-related factors
• Anaesthesia-related critical incidents may be
due to human errors, equipment errors, or
pharmacological factors.

7. Human Errors
• Human error is commonly associated with poor
training, fatigue, inadequate experience, lack of
communication and poor preparation of the
patient, the environment and the equipment
• Early recognition, vigilance and precision help to
prevent mortality
• The use of action plans and drills are necessary
for anaesthetists to prepare to manage critical
incidents when they occur

9. Equipment Failure
• Major causes of patient injury from
anaesthetic equipment:
– Insufficient oxygen supply
– Inadequate CO2 removal
– Barotrauma
– Excessive concentration of inhalational agent

10. Equipment Failure
• Meticulous checking of equipment before use
is mandatory.
• The anaesthetist must not only ensure the
correct functioning of items or equipment that
may be life-saving or of critical importance but
must also ensure that alternative devices are
available should the primary device fail

11. Prevention
• Monitors and alarms
• Education of caregivers and ancillary staff
• Regular service of equipment

12. Pharmacological Errors
• Definition: error in the prescription, dispensing, or
administration of a medication with the result that
the patient fails to receive the correct drug or the
indicated proper drug dosage
• Could be inappropriate dosing, wrong sequence of
administration, administration of a drug different
from what was intended, or administration of a drug
which the patient is allergic to
• Commoner during general anaesthesia than during
regional anaesthesia
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13. Webster’s Classification of Drug Errors
Omission: drug not given
Repetition: extra dose of an intended drug
Substitution: incorrect drug instead of the
desired drug; a swap
Insertion: a drug that was not intended to
be given at a particular time or at any time
Incorrect dose: wrong dose of an intended drug
Incorrect route: wrong route of an intended drug
Other: usually a more complex event not fitting the
categories above
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14. • Respiratory
• Cardiovascular
• Neurological
• Temperature
• Drug reactions
Critical Incidents in Anaesthesia

15. Respiratory
• Airway obstruction
• Difficult intubation
• Failed intubation
• Aspiration
• Hypoxia

16. Cardiovascular
• Hypertension
• Hypotension
• Arrhythmias
• Venous embolism

17. Neurological
• Awareness
• Cerebral ischaemia
• Peripheral nerve injury
Temperature
• Hypothermia
• Hyperthermia
• Malignant hyperthermia
• Burn injury

18. Drugs
• Hypersensitivity reactions

19. Prevention of Critical Incidents
• Preoperative assessment, investigation and
counselling of the patient
• Preoperative checking of equipment and the
assurance of backup equipment
• Availability of an appropriately trained assistant
• Preoperative consultation with more experienced
personnel, where necessary, regarding the most
appropriate anaesthetic technique
• Use of appropriate monitoring techniques

20. Conclusion
• Critical incidents can occur in the hands of the
highly skilled and even in the presence of
adequate monitoring.
• Protocols should be put in place to avoid
errors.
• Critical incident reporting must be encouraged
to improve patients’ safety and reduce
morbidity and mortality.