Anaesthesia and intensive care
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Anaesth Intensive Care · Oct 1993
Comparative StudyThe Australian Incident Monitoring Study. Paediatric incidents in anaesthesia: an analysis of 2000 incident reports.
The first 2000 incidents reported to the Australian Incident Monitoring Study (AIMS) were analysed to compare anaesthetic incidents in infants and children with those in adults. Of the 2000, 1790 (90%) involved adults, 151 (7%) children and 56 (3%) infants. Healthy children (ASA I) generated a greater proportion of incidents in this group than adults and infants, emphasizing the need for maintaining the same standards for children in this group as for infants and higher risk groups. ⋯ In the AIMS study procedures on the head and neck yielded proportionately more incidents in the infant/child group than in the adult group, as did incidents involving the respiratory and breathing circuit systems. Incidents in the child group were often detected clinically; however, there were no differences between the three age groups in the way monitors were used or performed; hence the same monitoring recommendations apply to all groups. Combined oximetry and capnography would have detected nearly 90% of all applicable problems in the AIMS study and could have prevented nearly 90% of the claims arising from inadequate ventilation in the US "closed claims" study.(ABSTRACT TRUNCATED AT 250 WORDS)
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Anaesth Intensive Care · Oct 1993
The Australian Incident Monitoring Study. Pneumothorax: an analysis of 2000 incident reports.
Eighteen (1%) of the first 2000 incidents reported to the Australian Incident Monitoring Study (AIMS) involved actual or suspected pneumothoraces; 17 were confirmed. Eleven of the patients were seriously ill beforehand. Four developed tension pneumothoraces, and in 2 incidents (1 tension) the pneumothoraces were bilateral. ⋯ Indications for central vein cannulation or trans-tracheal airway manoeuvres must be firm. Such procedures should always be followed by a closely scrutinised erect chest X-ray as soon as practicable. The possibility of a pneumothorax must always be considered when unexpected cardiorespiratory deterioration occurs.
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Anaesth Intensive Care · Oct 1993
The Australian Incident Monitoring Study. Errors, incidents and accidents in anaesthetic practice.
Human error is a pervasive and normal part of everyday life and is of interest to the anaesthetist because errors may lead to accidents. Definitions of, and the relationships between, errors, incidents and accidents are provided as the basis to this introduction to the psychology of human error in the context of the work of the anaesthetist. Examples are drawn from the Australian Incident Monitoring Study (AIMS). ⋯ Different strategies are required for the prevention of each type and it may now be useful to place more emphasis in anaesthetic practice on categories to which little attention has been directed in the past. "Latent" errors make an enormous contribution to problems in anaesthesia and several categories are discussed (e.g. environment, physiological state, equipment, work practices, personnel training, social and cultural factors). An approach is provided for the prevention and management of errors, incidents and accidents which allows clinical problems to be categorized, the relative importance of various contributing factors to be established, and appropriate preventative strategies to be devised and implemented on the basis of priorities determined from the AIMS data. Accidents cannot be abolished; however, an understanding of the factors underlying them can lead to the rational direction of resources and effort to prevent them and minimise their effects.
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Anaesth Intensive Care · Oct 1993
The Australian Incident Monitoring Study. The pulse oximeter: applications and limitations--an analysis of 2000 incident reports.
The first 2000 incidents reported to the Australian Incident Monitoring Study were analysed with respect to the role of the pulse oximeter. Of these 184 (9%) were first detected by a pulse oximeter and there were a further 177 (9%) in which desaturation was recorded. Of the 1256 incidents which occurred in association with general anaesthesia 48% were "human detected" and 52% "monitor detected". ⋯ The pulse oximeter is the "front-line" monitor for endobronchial intubation, the fourth most common incident in association with general anaesthesia (it detected 87% of the 76 cases in which it was in use). It also played an invaluable role as a "back-up" monitor in 40 life-threatening situations in which "front-line" monitors (e.g. oxygen analyser, low pressure alarm, capnograph) were either not in use, were being used incorrectly or failed. Other situations detected, in order of frequency of detection, were: circuit disconnection, circuit leak, desaturation (severe shunt), oesophageal intubation, aspiration and/or regurgitation, pulmonary oedema, endotracheal tube obstruction, severe hypotension, failure of oxygen delivery, hypoxic gas mixture, hypoventilation, anaphylaxis, air embolism, bronchospasm, malignant hyperthermia, and tension pneumothorax.(ABSTRACT TRUNCATED AT 250 WORDS)
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Anaesth Intensive Care · Oct 1993
The Australian Incident Monitoring Study. Problems before induction of anaesthesia: an analysis of 2000 incident reports.
The first 2000 incidents reported to the Australian Incident Monitoring study (AIMS) were examined to identify those incidents which occurred preoperatively (defined as occurring prior to the commencement of general or regional anaesthesia). The 35 incidents, representing 1.7% of the total, which occurred in this time period were analysed with a view to identifying areas in which current practice could be improved. Almost all incidents led to significant delays in operating lists, and 9 resulted in cancellation of surgery. ⋯ Problems with premedication drugs resulted in 8 of the 35 incidents, and care must be taken in the prescription and administration of these drugs to minimise adverse effects on patients. Only 2 cases of incorrect patient identification were reported. However, in view of its disastrous consequences, vigilance in patient identification by all members of the operating team, including the anaesthetist, is essential.