Deviation in the Standard of Anesthetic Care Resulting in Hypoxia or Brain Injury

Evaluate breaches in the standard of care when evaluating a Deviation in the Standard of Anesthetic Care Resulting in Hypoxia or Brain Injury

Answer the following questions to find out if the standard of care was followed for your case.

  • Was a thorough medical history obtained?
    Yes
    No
    Answer unknown Why is this important?
    A thorough history and physical examination should be performed to assess patient-related risk factors, the status of patient’s comorbid conditions and functional capacity. The clinician should elicit the following:
    • History of heart problems
    • History of lung conditions such as COPD, asthma, and TB
    • History of seizures
    • History of stroke or neuromuscular disorders
    • History of metabolic factors like obesity, diabetes
    • Family History of suxamethonium apnea
    • History of allergies, medications taken
    • History of previous anaesthetic exposure.

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  • Was a physical examination performed? Why is this important?
    Answer this question
    Selection of anaesthetic techniques and drugs begins with the pre-operative anesthetic evaluation. The clinician must conduct a thorough pre-anesthetic physical examination including airway, pulmonary and cardiovascular examination.
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  • Was an airway examination performed? Why is this important?
    Answer this question
    Airway management is perhaps the most critical skill in anesthesiology. The pre-operative evaluation focuses on recognition of patients who may be difficult to mask-ventilate or intubate.
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  • Which of the following diagnostic studies were performed? (Choose all that apply) Why is this important?
    Answer this question
    A thorough pre-anaesthetic evaluation of the patient’s cardiac and pulmonary status must be performed to assess the patient’s overall condition.
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  • Were the risk factors classified according to the “American Society of Anesthesiologists' Physical Status” scale? Why is this important?
    Answer this question
    The American society of anesthesiologists (ASA) classification system is helpful for identifying the risks of anesthesia through an assessment of the patient's underlying medical problems.
    (2006) 20 EBPRCA 2 249

  • Were the risks and complications associated with different modes of anesthesia explained to the patient? Why is this important?
    Answer this question
    Patients often desire information regarding the risk of death or major complications associated with each type of anesthesia.
    (2006) 20 EBPRCA 2 249-263

  • Was an informed consent obtained and documented? Why is this important?
    Answer this question
    The laws of most states require that surgeons obtain informed consent before providing treatment.
    (2011) 23 EOMSCA 3 475-484

  • Were pre-anesthetic medications administered to the patient? Why is this important?
    Answer this question
    Administration of pre-anesthetic medications with anxiolytic properties usually benefits the patient and assists the later conduct of anesthesia.
    (2010) 11 EAICMD 8 330-335

  • Was the patient advised to fast prior to the procedure? Why is this important?
    Answer this question
    Pre-operative patient fasting is an essential element of the patient preparation process. The goal of fasting is to empty the stomach, thereby reducing the risk of aspiration of stomach contents during the anesthetic period.
    (2007) 86 EAORNJ 4 609-612,614-617

  • Was an anesthesia equipment checkout performed and documented? Why is this important?
    Answer this question
    Anesthesia care providers must check their workstations appropriately before surgery with the correct pre-use checkout procedures to ensure safe delivery of anesthesia for every patient as required by the FDA.
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  • Was backup oxygen and suction available? Why is this important?
    Answer this question

  • Was the type of anesthesia and dosage administered, medically indicated? Why is this important?
    Answer this question
    The various types of anesthesia include; general anesthesia, neuraxial anesthesia (spinal and epidural anesthesia), peripheral nerve block, intravenous regional block, monitored anesthesia care and sedation.
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  • Was pre-oxygenation performed before induction and intubation? Why is this important?
    Answer this question
    Pre-oxygenation before induction and intubation is prophylaxis against hypoxia. It increases the alveolar oxygen concentration before tracheal intubation. It allows for a reserve of oxygen in the lungs during apnea.
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  • Was appropriate airway management performed? Why is this important?
    Answer this question
    Airway management is a critical part of the anesthesia practice. Management includes mask ventilation, laryngoscopy, endotracheal intubation and extubation of the patient.
    (2004) 18 EBPRCA 4 531-548

  • Was the endotracheal tube placement confirmed? Why is this important?
    Answer this question
    Unrecognized esophageal intubation leads to hypoventilation. Correct positioning of the endotracheal tube needs to be confirmed by the presence of breath sounds in all lung fields and regular carbon dioxide waveforms on the capnometer.
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  • Were the mandatory monitoring guidelines followed during anesthesia? Why is this important?
    Answer this question
    The ASA has established standards for basic anesthetic monitoring. These guidelines need to be followed during anesthesia. Pulse oximetry is used to monitor blood oxygen saturation, heart rate and tissue perfusion. Monitoring of delivered oxygen concentration (Fio2) and hemoglobin oxygen saturation is the standard of care during all general anesthetic procedures.
    Click here for additional information at asahg.org

  • Which of the following were monitored during the procedure? (Choose all that apply) Why is this important?
    Answer this question
    Effective monitoring is a critical aspect of anesthesia care. The essential components of monitoring include observation and vigilance, instrumentation, data analysis, and institution of corrective measures, if indicated. The ASA has established standards for basic anesthetic monitoring. These have been designed to integrate clinical skills and electronic monitoring with the goal of enhancing patient safety. Although it is difficult to relate improved patient outcomes with specific monitors directly, the reduction in anesthesia-related morbidity and mortality has paralleled the institution of current monitoring practices.
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  • Was the adequacy of mechanical ventilation continually evaluated? Why is this important?
    Answer this question
    During mechanical ventilation, monitors of airway pressure and minute ventilation alert the anesthesiologist to conditions that can impair ventilation. The adequacy of mechanical ventilation needs to be continually evaluated during the intra-operative period by observation of the reservoir breathing bag and qualitative clinical signs like chest extrusion, auscultation of breath sounds, quantitative monitoring of the co2 content and the volume of the expired gas, capnometry and mechanical tidal volume and rate measurement.
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  • Was there a period of desaturation during the course of anaesthesia? Why is this important?
    Answer this question
    It is paramount to avoid periods of oxygen de-saturation, which very quickly suppress cardiac function and reduce cardiac output. Pulse oximetry, a non-invasive monitoring devise detects periods of oxygen de-saturation immediately.
    (2012) 70 JLOAMS 11S3 e31-e49