Anesthetic RisksAnesthetic Risks

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Causes of Anesthetic RisksCauses of Anesthetic Risks

• Man – Knowledge – Skills– Vigilance / Negligence– Teamwork / Holistic

• Anesthetists & Surgeons• Treat underlying diseases

– HT, DM, Electrolyte imbalance, Volume status

Causes of Anesthetic RisksCauses 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 RisksCauses of Anesthetic Risks

• Management – Risk Management– Incident Report– M&M Conference– Practice Guidelines– CQI & TQM

Anesthetic RisksAnesthetic Risks

• GA vs. RA– Equivalent risks

• GA– Airway management– Aspiration – Drugs side-effects & Interactions

Anesthetic RisksAnesthetic 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 RulesSafety 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 RulesSafety Rules

• Intra-operative– Always communicate– Alert & Vigilance– No negligence– Avoid drug errors

Safety RulesSafety 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 EndThe End

Thank you for your attention Thank you for your attention

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