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At least 109 records · Page 6Linked to original sources
PubMed1992

Effect of pulse oximetry, age, and ASA physical status on the frequency of patients admitted unexpectedly to a postoperative intensive care unit and the severity of their anesthesia-related complications.

Unanticipated intensive care unit admission (UIA) associated with anesthesia served as an outcome measure to assess the quality of anesthesia care in a large teaching hospital. We characterized the patient population and types of problems associated with UIAs, attempted to identify patterns of care that could have led to specific adverse outcomes, and determined if a specific intervention, pulse oximetry, reduced UIAs. During a consecutive 65-wk period (July 1985-September 1986), 17,093 surgical patients were expected to enter the recovery room and then return to floor care. Seventy-one patients (0.42%) experienced a UIA from either the recovery room or operating room, and the circumstances of their admissions were analyzed in detail. After introduction of pulse oximetry in all anesthetizing locations (not including the recovery room) in the 29th week, the overall rate of UIAs and, specifically, the rate of UIA to rule out myocardial infarction, decreased significantly. Increasing ASA physical status (ASA-PS) and age significantly increased the probability of UIA. UIA patients with ASA-PS III/IV had a significantly higher acuity in the intensive care unit and were far more likely to die during their hospitalization than ASA-PS I/II patients. Retrospective review of UIAs alone did not identify patterns of care requiring remediation, which leads us to question the utility of UIAs as a generic screen for quality assurance.

Adult↗
PubMed1988

Legal abortion mortality and general anesthesia.

Legal abortion-related mortality as reported to the Centers for Disease Control declined eightfold between 1972 and 1981. However, the causes of legal abortion mortality have changed over time. We reviewed all legal abortion-related deaths that occurred between 1972 and 1985 in the United States. We found that, although the absolute number of legal abortion-related deaths caused by general anesthesia complications did not increase, the proportion of such deaths increased significantly, from 7.7% between 1972 and 1975 to 29.4% between 1980 and 1985. Women who died of general anesthesia complications did not differ by age, presence of preexisting medical conditions, or type of facility from women who died of other causes. However, the proportion of deaths from general anesthesia complications was significantly higher among women of black and other races, women obtaining abortions during the first trimester, and women obtaining abortions in the Northeast. Our results indicate that at least 23 of the 27 deaths were due to hypoventilation and/or loss of airway resulting in hypoxia. Persons administering general anesthesia for abortion must be skilled in airway management as well as the provision of general anesthesia.

Abortion, Legal↗
PubMed2004

A matched comparison study of medical and psychiatric complications and anesthesia and analgesia requirements in methadone-maintained liver transplant recipients.

Approximately 85% of patients receiving methadone maintenance therapy (MMT) for opiate dependence in the United States are infected with hepatitis C virus (HCV). MMT is significantly underrepresented in most liver transplant programs, but the number of patients receiving MMT is increasing and few data are available to guide treatment. We evaluated MMT in our program (27 pretransplant and 10 posttransplant cases) for medical and psychiatric complications and anesthesia and analgesia requirements. After transplant, 10 patients receiving MMT were compared with a matched control group of 19 patients who were not receiving MMT and not dependent on opiates. Fewer patients receiving MMT retained a spot on the transplant waiting list (65%) than patients not receiving MMT (80%); 30% of patients receiving MMT pretransplant used heroin, cocaine, or marijuana, and more than 25% were lost to follow-up. Liver disease according to mean Child-Turcotte-Pugh (CTP) score and transplant waiting times was similar between the 2 groups. Patients receiving MMT required significantly more intraoperative anesthesia and postoperative analgesia (mean fentanyl 3,175 microg/d, SD = 2,832; intravenous morphine 67.86 mg/d, SD = 38.84, respectively) compared with patients not receiving MMT (mean fentanyl 1,324 microg/d, SD = 1,122; intravenous morphine 12.17 mg/d, SD = 10.24, respectively). More patients receiving MMT had severe recurrent HCV infection (60%) and worse survival (60%) versus patients not receiving MMT (21% and 78.9%, respectively). Follow-up times did not differ between groups (MMT: mean 4.19 years, median 1.15 years, SD = 7.6; non-MMT: mean 2.68 years, median 2.19 years, SD = 1.73). Finally, patients receiving MMT required an average methadone dose increase of 60% from pretransplant to posttransplant. Postoperative analgesia guidelines are described. Posttransplant, 20% of patients receiving MMT used alcohol or illicit drugs. Data do not support withholding the provision of liver transplantation to patients receiving MMT, but larger, well-controlled studies are warranted.

Adult↗
PubMed1994

Internal carotid artery dissection after remote surgery. Iatrogenic complications of anesthesia.

BACKGROUND: Subintimal dissection with acute occlusion of the internal carotid artery resulting in acute cerebral infarction has not been reported as an iatrogenic complication of general anesthesia. CASE DESCRIPTIONS: An anesthetist stretched the neck of a 44-year-old man by anchoring an anesthesia mask posterior to the angle of the jaw with overlying fingers as the patient struggled during an insufficient inhalational mask anesthetic. A 33-year-old man received an endotracheal anesthetic without struggle, but as he was turned from a supine to a prone position, his head and neck were not immobilized to rotate with his torso during the move. The next day both patients suffered acute cerebral infarctions secondary to ICA dissections and occlusions (angiographically demonstrated). CONCLUSIONS: Stretching the soft neck tissues of anesthetized patients can cause internal carotid artery dissection and acute cerebral infarction.

Adult↗
PubMedDate not supplied

Complications of spinal anesthesia.

Serious neurological complications after spinal anesthesia are rare, but do occur. The most common are postdural puncture headache and hypotension. Hypotension after spinal anesthesia is a physiological consequence of sympathetic blockade. The diagnoses and management of these sequelae are discussed.

Anesthesia, Spinal↗
PubMed1998

Epidural abscess complicating epidural anesthesia and analgesia. An analysis of the literature.

BACKGROUND: Epidural abscess is a serious complication of epidural block. Because of its low incidence, the risk factors and the symptoms and cause of epidural abscess related to epidural anesthesia and analgesia are not well known by anesthesiologists. METHODS: A computer-assisted search of the literature on epidural catheter-related abscess was performed to describe the clinical course and bacteriology of this complication, to determine possible risk factors, and to assess the index of suspicion among physicians. RESULTS: Forty-two patients with a catheter-related epidural abscess were identified. Only in 15 patients was the correct diagnosis considered initially. The time from insertion of the epidural catheter to symptoms varied between 1 and 60 d. Initial symptoms included back pain, fever, and leukocytosis. The time from symptoms to treatment was a few hours to 108 d. Interval from first symptoms to treatment was significantly longer in patients with persistent neurologic deficits compared with patients who completely recovered. Staphylococcus aureus was the most common etiologic agent. Outcome was reported in 39 patients, but only 19 made a full recovery. CONCLUSION: The index of suspicion among anesthesiologists, other physicians and nurses taking care of patients with epidural catheters must be increased for this complication; this should shorten the interval from symptoms to treatment and lower the incidence of neurological sequelae.

Abscess↗
PubMed2000

A comparative study of topical vs retrobulbar anesthesia in complicated cataract surgery.

OBJECTIVES: To evaluate and compare levels of patient discomfort and perioperative complications during phacoemulsification and implantation of a foldable intraocular lens under topical lidocaine hydrochloride and retrobulbar anesthesia in patients with cataract who also had exfoliation syndrome, uveitis, posterior synechia, phacodonesis, or previous intraocular surgery. DESIGN: A prospective, randomized, controlled trial was carried out at 2 institutions. PARTICIPANTS: A total of 476 eyes of 476 patients with various well-established risk factors fulfilled the inclusion criteria. In 238 eyes, phacoemulsification was performed under retrobulbar anesthesia, while the other 238 eyes received topical anesthesia. INTERVENTIONS: All patients underwent temporal clear corneal phacoemulsification and implantation of a foldable intraocular lens. Patients under retrobulbar anesthesia received a single injection (3. 5-5.5 mL) of a combination of 0.75% bupivacaine hydrochloride, 2% lidocaine, and hyaluronidase into the retrobulbar space. Patients in the topical anesthesia group received a minimum of 5 doses (approximately 40 microL per dose) of 2% topical lidocaine. No intracameral injection of any anesthetic was given. MAIN OUTCOME MEASURES: The number of complications and adverse events. The intraoperative conditions were judged by the surgeon (P.C.J. or F.K. J.), and a 10-point visual analog scale was used immediately after surgery to assess each patient's overall severity of intraoperative pain. RESULTS: The overall intraoperative complication rate was 1.9% for capsular tear, 3.8% for zonular tear, 1.5% for vitreous loss, and 1.0% for iris prolapse. Apart from the incidence of vitreous loss, which was significantly (P =.041) lower in the topical anesthesia group, no statistically significant differences in intraoperative and early postoperative complications were found between the groups. A supplemental posterior sub-Tenon space injection was required in 1.3% of the topical anesthesia group and in 0.8% of the retrobulbar anesthesia group. Chemosis (2.5%), subconjunctival hemorrhage (1.7%), and periorbital hematoma (0.8%) were seen only in the retrobulbar anesthesia group. The mean + SE pain scores estimated by the patients were 0.84 + 1.30 in the topical anesthesia group and 0.73 + 1.50 in the retrobulbar anesthesia group (P =.41). Patient preference for topical anesthesia (91%) appeared to be significantly (P =.01) higher than for retrobulbar anesthesia (62%). The surgeons found anesthesia-related intraoperative difficulty to be slightly lower in the retrobulbar anesthesia group (8%) than in the topical anesthesia group (14%). CONCLUSIONS: Surgery-related complications and patient discomfort were similar for the 2 methods of anesthesia. Topical anesthesia is justified as a means of improving safety without causing discomfort to the patient even in complicated cases of cataract surgery. Arch Ophthalmol. 2000;118:1037-1043

Administration, Topical↗
PubMed1991

Complications of foot surgery. Complications of anesthesia.

Anesthesia is a necessity when performing surgery. As with any component of the surgical task, there are complications associated with any of the various anesthetic agents and techniques. The most effective way to diminish a complication is through prevention. A detailed medical history and examination of the patient will alert the physician to possible hazards along the surgical path. Dialogue with the anesthesiologist to promote teamwork is always in the patient's best interest and can lower the complication rate.

Aged↗
PubMed2006

[The use of questionnaires for rotating residents in evaluating training in anesthesiology].

BACKGROUND: We prepared questionnaires for the rotating residents during their assignment for anesthesiology in the novel Japanese residency programs for the year 2004. METHODS: Questionnaires consisting of 39 items with 235 model answers for these items were prepared. The residents underwent three interviews by these questionnaires over the three-month training period. The number of correct answers for these questionnaires was recorded and evaluated using a computer database software. RESULTS: There was no significant correlation between the results of these questionnaires and the subjective evaluation by supervisors conducted during clinical training. On stepwise regression analysis, the results of the questionnaires for "American Society of Anesthesiologists Physical Status", "contraindications for epidural anesthesia", "complications of general anesthesia" and "initial procedures for patients in the operating room" correlated with the subjective evaluation by supervisors. CONCLUSIONS: Stepwise regression analysis was shown to be helpful in improving the questionnaires regarding the training in anesthesiology.

Anesthesiology↗
PubMedDate not supplied

[Complications of anesthesia and their prevention in children with spastic cerebral palsy during ambulatory surgery].

A total of 8000 anesthesias with ketamine or ketamine + halothane in children with infantile cerebral paralysis, operated in a one-day hospital, are analyzed. The complications were as follows: tachycardias in 12%, hypotonia in 8%, repeated vomiting in 5%, postnarcosis depression in 10%, psychomotor excitation in 9%, and painful syndrome in 7%. The most incident combination of complications was hypotonia, tachycardia, repeated vomiting, and postnarcosis depression. Complications occurred in 14.2% cases in ketamine anesthesia and in 4.3% cases in halothane + ketamine anesthesia.

Adolescent↗
PubMed2002

Subdural block complicating spinal anesthesia?

IMPLICATIONS: Features suggestive of subdural block appeared after an apparently normal subarachnoid block. The long bevel of the reusable Quincke-type spinal needle may have contributed to the development of this complication. We propose that spinal needles should have a smaller bevel to minimize the possibility of such a complication.

Anesthesia, Spinal↗