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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