Download Anesthetic Risks - @@ Home

Anesthetic Risks
รศ.นพ.เทพกร สาธิตการมณี
ั ญีวท
หัวหน ้าภาควิชาวิสญ
ิ ยา
คณะแพทยศาสตร์ มหาวิทยาลัยขอนแก่น
Causes of Anesthetic Risks
• Man
– Knowledge
– Skills
– Vigilance / Negligence
– Teamwork / Holistic
• Anesthetists & Surgeons
• Treat underlying diseases
– HT, DM, Electrolyte imbalance, Volume status
Causes of Anesthetic Risks
• Materials
– Standard : EKG, Pulse oximeter, NIBP,
Capnograph
– Adequacy : Spare units
– Routine check-up before each case
– Preventive maintenance & Calibration
– Pay attention to any alarms
– Do not suspend alarms
Causes of Anesthetic Risks
• Management
– Risk Management
– Incident Report
– M&M Conference
– Practice Guidelines
– CQI & TQM
Anesthetic Risks
• GA vs. RA
– Equivalent risks
• GA
– Airway management
– Aspiration
– Drugs side-effects & Interactions
Anesthetic Risks
• RA
– Bezold-Jarisch reflex (severe bradycardia –
hypotension – cardiac arrest)
– High block  Total spinal block
• Hypotension, bradycardia, cardiac arrest
• Respiratory insufficiency  Apnea
– Inadequate block
• Light sedation : Never heavy sedation
• GA
– Systemic toxicity of local anesthetics
• Convulsion  Apnea  CVS depression  Cardiac arrest
– Neurological deficit
Safety Rules
• There is Minor Surgery  but no
Minor Anesthesia
• Pre-operative preparation
– Standard for all
– NPO time : always strict to the rule
– Good teamwork
– No compromise
Safety Rules
• Intra-operative
– Always communicate
– Alert & Vigilance
– No negligence
– Avoid drug errors
Safety Rules
• Post-operative
– Extubate ???
– Ventilate ???
– Appropriate assessment
•
•
•
•
•
•
Extubation/Ventilation Criteria
Day or Night
ASA Classification
Pre-operative risk factors
General or Private ward
If ambiguous : Over-treatment > Under-treatment
The End
Thank you for your attention 
Q&A