This Article Résumé de cet Article Full Text Full Text (PDF) Submit a scholarly reply Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Fasting, S. Articles by Gisvold, S. E. Search for Related Content PubMed PubMed Citation Articles by Fasting, S. Articles by Gisvold, S. E.

Serious intraoperative problems – a five-year review of 83,844 anesthetics

[Problèmes peropératoires graves – une revue de 83 844 anesthésies sur cinq ans]

From the Department of Anesthesia and Intensive Care, St. Olav's Hospital, University Hospital of Trondheim, Trondheim, Norway.

Address correspondence to: Dr. Sigurd Fasting, Department of Anesthesia and Intensive Care, St. Olav's Hospital, University Hospital of Trondheim, N-7006 Trondheim, Norway. Phone: +47-73868108; Fax: +47-73868117; E-mail: sigurd.fasting{at}medisin.ntnu.no

Purpose: The low incidence of mortality and major morbidity in anesthesia makes it difficult to study the pattern of potential accidents and to develop preventive strategies. Anesthetic ‘near-misses’, however, occur more frequently. Using data from a simple routine-based system of problem reporting, we have analyzed the pattern and causes of serious non-fatal problems, in order to improve preventive strategies.

Methods: We prospectively recorded anesthesia-related information from all anesthetics for five years. The data included intraoperative problems, which were graded into four levels, according to severity. We analyzed only the serious nonfatal problems, which were sorted according to clinical presentation, and also according to which factor was most important in the development of the problem. We assessed any untoward consequences for the patient, and whether the problems could have been prevented.

Results: Serious problems were recorded in 315 cases out of 83,844 (0.4%). Anesthesia was considered the major contributing factor in 111 cases. Difficult intubation, difficult emergence from general anesthesia, allergic reactions, arrhythmia and hypotension were the dominating problems. Twenty-six anesthesia related problems resulted in changes in level of postoperative care, and one patient later died in the intensive care unit after anaphylactic shock. Eighty-two problems could have been prevented by simple strategies.

Conclusion: Analysis of serious nonfatal problems during anesthesia may contribute to improved preventive strategies. Data from a routine-based system are suitable for this type of analysis. Intubation, emergence, arrhythmia, hypotension and anaphylaxis cause most serious problems, and should be the object of preventive strategies.

This article has been cited by other articles:

				C. M. Burkle, M. T. Walsh, B. A. Harrison, T. B. Curry, and S. H. Rose Airway management after failure to intubate by direct laryngoscopy: outcomes in a large teaching hospital: [Le controle des voies aeriennes apres l'echec de l'intubation par laryngoscopie directe : resultats obtenus dans un grand hopital universitaire] Can J Anesth, June 1, 2005; 52(6): 634 - 640. [Abstract] [Full Text] [PDF]

				G. Luckner, J. Margreiter, S. Jochberger, V. Mayr, T. Luger, W. Voelckel, A. J. Mayr, and M. W. Dunser Systolic Anterior Motion of the Mitral Valve with Left Ventricular Outflow Tract Obstruction: Three Cases of Acute Perioperative Hypotension in Noncardiac Surgery Anesth. Analg., June 1, 2005; 100(6): 1594 - 1598. [Abstract] [Full Text] [PDF]

				J. R. Maltby, S. Pytka, N. C. Watson, R. A. McTaggart Cowan, and G. H. Fick Drinking 300 mL of clear fluid two hours before surgery has no effect on gastric fluid volume and pH in fasting and non-fasting obese patients: [Le fait de boire 300 mL de liquide clair deux heures avant d'etre opere n'a pas d'effet sur le volume de liquide ni sur le pH gastriques chez des patients obeses a jeun ou non] Can J Anesth, February 1, 2004; 51(2): 111 - 115. [Abstract] [Full Text] [PDF]

				D. L. Hepner and M. C. Castells Anaphylaxis During the Perioperative Period Anesth. Analg., November 1, 2003; 97(5): 1381 - 1395. [Abstract] [Full Text] [PDF]

				S. Fasting and S. E. Gisvold Statistical process control methods allow the analysis and improvement of anesthesia care: [Les methodes de controle statistique du processus permettent d'analyser et d'ameliorer les soins anesthesiques] Can J Anesth, October 1, 2003; 50(8): 767 - 774. [Abstract] [Full Text] [PDF]