1. Anesthetic Risks รศ.นพ.เทพกร สาธิตการมณี หัวหน้าภาควิชาวิสัญญีวิทยา คณะแพทยศาสตร์ มหาวิทยาลัยขอนแก่น

2. Causes of Anesthetic Risks Man –Knowledge –Skills –Vigilance / Negligence –Teamwork / Holistic Anesthetists & Surgeons Treat underlying diseases –HT, DM, Electrolyte imbalance, Volume status

3. 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

4. Causes of Anesthetic Risks Management –Risk Management –Incident Report –M&M Conference –Practice Guidelines –CQI & TQM

5. Anesthetic Risks GA vs. RA –Equivalent risks GA –Airway management –Aspiration –Drugs side-effects & Interactions

6. 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

7. 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

8. Safety Rules Intra-operative –Always communicate –Alert & Vigilance –No negligence –Avoid drug errors

9. 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

10. The End Thank you for your attention Thank you for your attention Q & A