Anesthesia complications range from minor to catastrophic. complications of general anesthesia might be due to difficulty in airway management or ventilation. Also the complication might be due to cardiac arrhythmias and poor response to anesthetic effect during induction or maintenance or even the emergence from anesthesia. So, the the systematic response to the effect of the anesthesia may occur at any time during surgery. Some of the complications: Hypoxia, arrhythmia, hypotension , hypertension, regurgitation and aspiration, hypothermia hypoglycemia, coronary ischemia, embolism, persistent apnea delayed recovery , and many others. also regional anesthesia has its complications like nerve injury, post spinal headache. Toxicity from local anesthesia is one of the important complication might occur during local infiltration.

1. Complications of Anesthesia
Mahmood Hasan Taha
H.D Anesthesia
Head of Anesthesia Dep.
Zakho Emergency H.
May 2018

3.  Are inevitable even with most experienced
doctors.
 These complications range from minor to
to catastrophic.

4. Complications of G.A
 Intraoperative complications.
 Postoperative complications.

5. Intraoperative complications
Due to:
 Laryngoscopy.
 ETT
 Induction.
 Maintenance.

6. Complications of laryngoscopy

7. Trauma to:
 lips
 Teeth
 Tonque
 Tonsillar pillar
 Epiglottis.
 Vocal Cords.

8. Complications of ETT

9.  Injury to vocal cords.
 Injury to trachea.
 Blockage of tube – secretions, blood clot,
foreign body.
 Bronchospasm.

10. Complications of Anesthetics
(Induction)

11.  Hypotension, Hypertension.
 Arrhythmias: bradycardia, tachycardia, SVT,
arrest.
 Hypoventilation, upper airway obstruction.

12.  Histamine release: bronchospasm, anaphylaxis.
 Regurgitation, Aspiration:
mendelson’s syndrome ?.

13. Maintenance

14.  All the above.
 Hypothermia/ Hyperthermia - MH ?
 Hypoglycemia/Hyperglycemia.

15.  Less or over fluid infusion.
 Electrolyte imbalance.
 Blood loss, Anemia.
 Accidental: kinking, disconnection of ETT or
curcuit.

16.  Thyroid crisis/ Hypothyroidism.
 Coronary ischemia, Heart failure, MI.
 Embolism: fat, air, amniotic.

17. Post operative complications

18.  Persistent apnea: residual MR?, dual block?
scoline?
 Post extubation laryngospasm, bronchospasm.
 Hypoxia, Hypercarbia.
 Delayed recovery.
 Regurgitation, aspiration.

19.  Hypothermia → shivering …?!!
 PONV (20 – 30% at recovery room).
 Hoarseness of voice.
 Sore throat.

20.  Atelectasis, Cough.
 Tracheitis.
 Tracheal stenosis.
 Halothane induced hepatitis.

21. Complications of positioning

22.  Nerve injury:
 Regional A. & GA. abolish protective reflexes &
predispose patient to injury.
 Peroneal n, Ulnar n., Radial n., Brachial plexus.
 Any position, lithotomy, lateral decubitus.

23.  Patient with contractures → positioned before
induction of anesthesia.
 Final positioning should be evaluated before
draping.
 Sensory or motor dysfunction → usually
temporary (2-12 weeks).
 Nerve conduction or EMG are indicated to
document where the damage is new or chronic.

24. position
Complication
Sitting, prone, Reversed
Trendelenburg.
Venous air embolism
Lithotomy
Extremity compartment
syndrome
Prone, Sitting
Retinal ischemia

25. Position
Complication
any, specially prone
Corneal abrasion-ION
any
Backache
Supine, Lithotomy,
Trendelenburg.
Alopecia
any
Skin necrosis

26. Awareness

27. Intraoperative awareness → mild anxiety to PTSD
 Incidence:
 Auditory perceptions: 50% (ASA 2008).
 Non obstetrics and non cardiac surgeries ≈0.1%
to 0.2%

28.  Cardiac surgery: 1.1% to 1.5%
 Obstetric 0.4%
 Trauma 11% to 43%

29.  Risk factors:
 Light level of anesthesia: hypovolemic, injured,
obstetric patient.
 Prior history of awareness.
 Cardiac surgery.
 Using MR (awake paralysis).

30.  Empty vaporizers.
 IV machine malfunction or disconnection.
 Chronic substance abuse.

31.  Chronic pain patient.
 Medication errors.
 Hypernatremia.

32. Hearing loss
 Usually transient, unrecognized.
 Post dural puncture: 50%
 Post G.A: barotrauma, vascular injury.
 Drugs: aminoglycoside, NSAID, loop diuretics.
 Post cardiac surgery: unilateral, embolism?

33. Human errors that may lead to
preventable anesthetic accident
 Unrecognized breathing circuit disconnection.
 Mistaken drug administration.
 Airway mismanagement.

34.  Anesthesia machine misuse.
 Fluid mismanagement.
 Intravenous line disconnection.

35. Complications of Neuroaxial Block

36.  Common:
 Hypotension, Bradycardia….?
 ↑ sensitivity to sedative medications.
 Nausea & Vomiting…..?
 Postdural puncture headache….?
 Back pain & paresthesia….?

37.  Less common:
 Nerve injury.
 Cauda equina syndrome.
 Total spinal.
 Meningitis.
 Hematoma, abscess formation.

38. Complications of Regional Anesthesia

39. Systemic
 CNS toxicity:
 Headache, tinnitus, perioral numbness,
confusion.
 Muscle twitching, visual hallucinations.
 Seizures, LOC, apnea.

40.  CVS toxicity:
 Hypertension, tachycardia.
 ↓COP → Hypotension.
 Bradycardia, arrhythmias, arrest.