Anesthesiology clinics of North America
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The number of patients who have preoperative anxiety over possibly "waking up" in the middle of surgery has increased dramatically over the last decade. McCleane and Cooper found that more than 50% of 247 patients were concerned that they would not be asleep during their surgery. Even after having an adequate anesthetic, 25% were still worried about being asleep with future anesthetics. ⋯ For the patient, awareness or recall while under general anesthesia is a frightening experience that can lead to debilitating emotional injury and even post-traumatic stress disorder. For anesthesiologists, awareness under anesthesia ranks second only to death as a "dreaded" complication. This chapter reviews the incidence, etiology, psychological sequelae, medicolegal consequences, and prevention of awareness during anesthesia.
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Anesthesiol Clin North America · Sep 2002
ReviewUlnar nerve injury and perioperative arm positioning.
Primum non nocere. Hippocrates included this admonition in Epidemics, Book I, Second Constitution, to do good or "to do no harm." However, even the most conscientious health care provider will encounter unexpected and serious adverse medical events. ⋯ In addition, these injuries may result in chronic pain or paresthesia, employment disability, catastrophic economic damages, and malpractice litigation. We will explore the current understanding of perioperative ulnar nerve dysfunction by summarizing the relevant scientific literature and information within the ASA closed-claims database, describing the epidemiologic features of perioperative nerve injuries, discussing relevant clinical investigations and recommendations for safe arm positioning during anesthesia, and reviewing the medico-legal issues inevitably intertwined with this topic, particularly the doctrine of res ipsa loquitur.
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This chapter discusses the cases of postoperative blindness reported in the literature and the theories that attempt to explain the mechanisms involved. Although uncommon, alterations in vision and blindness after anesthesia for major surgical procedures, particularly cardiopulmonary bypass or spine surgery, are well documented, with an incidence varying between 0.05% and 1%. ⋯ However, the large number of case reports over many years has provided some significant information. Although sustained compression of the eye is an important cause, postoperative visual loss may also occur, in an unrelated manner, because of ischemic optic neuropathy, central retinal artery or vein occlusion, or cortical blindness.
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Anesthesiol Clin North America · Sep 2002
ReviewThe Closed Claims Project. Has it influenced anesthetic practice and outcome?
Although there are intrinsic limitations in the analysis of closed malpractice claims, the Closed Claims Project has identified important anesthetic complications and mechanisms of injury and stimulated research in problem areas. The decrease in severity of injury in anesthesia malpractice claims suggests that anesthesia safety has improved since the establishment of monitoring standards using pulse oximetry and end-tidal capnography.
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The wide variety of peripheral blocks makes for a difficult endeavor in trying to grasp their many potential complications. However, the common features of these complications makes it possible to use the construct presented here, in combination with one's knowledge of anatomy, to be able anticipate many, if not most, of the complications of any particular peripheral regional anesthetic.