Anesthetic Risks รศ.นพ.เทพกร สาธิตการมณี หัวหน้าภาควิชาวิสัญญีวิทยา 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

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