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PubMed1987

Effects of information feedback and pulse oximetry on the incidence of anesthesia complications.

No standard outcome measures exist to evaluate the effect of interventions intended to improve the quality of anesthesia care. The authors established a clinically practical definition of outcome, and used it to assess the effect of feedback of information about complications and the effect of pulse oximetry on the rate and severity of important anesthesia-related problems encountered in the operating room (OR) and recovery room (RR). On admission to the RR, the patient's anesthetist documented Recovery-Room-Impact Events (RRIE), defined as an "unanticipated, undesirable, possibly anesthesia-related effect that required intervention, was pertinent to recovery-room care, and did or could cause at least moderate morbidity." Following a control period with no feedback of data, intense feedback of grouped (anonymous) RRIE rates was provided. Later, pulse oximeters were introduced to all anesthetizing locations. Among 12,088 patients (71% of all RR admissions), 18% had at least one RRIE in the OR or RR. The most common RRIEs were hypotension (4.4%), arrhythmia (3.9%), hypertension (1.5%), intubation difficulties (0.8%), hypoventilation (0.8%), and hypovolemia (0.6%). Feedback of information produced no demonstrable change in the rate of RRIEs. Although significantly fewer patients experienced RRIEs (15.6% vs. 12.4%, P less than 0.0001), hypotensive RRIEs (5.2% vs. 3.8%, P = 0.0003), and hypovolemic RRIEs (0.88% vs. 0.42%, P = 0.0017) following the introduction of pulse oximetry in the OR, confounding factors prevent establishment of a cause-and-effect relationship. Quality assurance may require more direct intervention and individual feedback to be effective. Still, the RRIE measure requires minimal effort at low cost and encourages improved transmission of information at the time of admission to recovery-room care.

Anesthesia↗
PubMed1989

Brain-stem anesthesia complicating retrobulbar block.

A previously well 68-year-old man became confused and cyanotic after retrobulbar block for eye surgery. The symptoms resolved within 10 minutes. The author discusses the differential diagnosis of brain-stem anesthesia and proposes recommendations to reduce the incidence of this potentially fatal complication.

Aged↗
PubMedDate not supplied

Laparoscopic sterilization with local anesthesia: complications and blood-gas changes.

Arterial blood-gas changes were studied in 21 healthy women undergoing laparoscopic sterilization with local anesthesia and supplemental IV sedation, employing CO2 as the inflating gas. No significant hypercarbia was noted. Two patients became transiently apneic following IV medication and 2 became extremely agitated during the procedure. This constituted a major nonsurgical complication rate of 19 percent. Safety requirements for patients undergoing this procedure is suggested.

Adult↗