ANESTHESIOLOGY

ANESTHETIC COMPLICATIONS EXIMIUS

AA Dr. Romina Alexis Pinson-Sulit June ata 2020 2021
Anesthetic Complications  It is often impossible to assign the responsibility for a poor outcome
Frequently asked questions: to the patient’s inherent disease, the surgical procedure, or the
 Will I lose my memory after general anesthesia? anesthetic management.
 Is there a chance I won’t wake up after general anesthesia?
 Will I be paralyzed after spinal anesthesia?
 Will I DIE?
E.g. Michael Jackson
 Propofol  Addiction  (fast administration of propofol
may lead to apnea)  Cardiac arrest
E.g. Business woman year 2017
 Prolonged plastic surgery (7pm to 3 am)  under general
anesthesia @ 2am hemodynamics crashed  not
managed  cardiac arrest

 Complications related to the delivery of anesthesia care are

inevitable.
 Anesthetic mishaps can be categorized as preventable or
unpreventable.
 When complications do occur, appropriate evaluation,
management, and documentation are critical in minimizing or
eliminating negative outcomes.
General Anesthesia
Most common complications
 Difficult airway
 Airway injury – during intubation/ laryngoscopy
 Hypoxia/hypoxemia
o During anesthetic induction and you don’t give enough
oxygen initially to the patient prior administration of
propofol/ muscle relaxant patient can go to hypoxia (99 
60%) desaturation and blood will not have oxygen 
hypoxemia
 Corneal abrasion: Most common complication of G.A.
o Because GA gases have inherent properties to dry the
eyes that’s why we tape the eyes before administration.
 Intraoperative awareness
o Evidence of awareness under GA was found to be
0.2-0.4%
o 20% were for awake paralysis
o Recall- more likely in women and when anesthesia relying
on opioids and muscle relaxants without volatile
anesthetic was used.
o Seen during Cardiac operations e.g. CABG
o Bitetral index monitor: Monitors if patient is awake
 Score of 40- sleeping
 Score of 60- patulog palang
 Score of 80- fully awake

Ranked low in the law suit due to complications, why?

 In the past 30 years, the mortality rate attributable
primarily to anesthesia appears to have dropped.
 Increased monitoring and awareness of anesthesiologist.
 From 1-2: 3,000 anesthetic experiences to a current
rate of 1-2: 20,000 experiences.

This decline may be due to:

1. New monitoring equipment
 New machines, better gases
 Video laryngoscope: gives high success for intubation
 Ultrasound
2. Knowledge of anesthetic physiology and pharmacology
3. Improved surgical and medical care

TRANSCRIBERS Group 3 EDITOR besm

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 EXIMIUS
ANESTHETIC COMPLICATIONS 2021
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Spinal Anesthesia
Other preventable complications:
 Allergic reactions: preservatives (PABA)
 Local anesthetics
 Neuromuscular blockers
 NSAIDS
 Propofol

 Peripheral Nerve injury: put pads under bony prominences

 Due to patient positioning
o Most common PNI: common peroneal
nerve: lithotomy position.
Sudden Cardiac arrest  Regional technique
 During an otherwise routine administration of spinal anesthetic  Hemodynamic instability
is an uncommon but catastrophic complication o Give fluid and pressors so when blood vessels dilate
 Sympathetic blockade (dilate vessels) increased vagal tone there will still be a source for cardiac output.
 decreased cardiac output bradycardia hypotension then
cardiac arrest
 Management

LAST: Local Anesthetic Systemic Toxicity

- MC complication of Spinal Anesthesia
- Bupivacane

TRANSCRIBERS Group 3 EDITOR : besm 2of2