Anesthetic Problems and Emergencies

A&A pg. 319

Why Do Problems Arise?

Human error Equipment error Adverse effects Patient factors

Anesthetic problems will inevitably occur at some point in your career.

No anesthetic experience is the same, so beware of the false sense of security!

Human Error Failure to obtain an adequate history or

physical exam on the patient Ideally, every patient scheduled for anesthesia

should have a complete PE, and a thorough history obtained with the owner present.

*Less than ideal circumstances are common: Owner drops patient off in a hurry Patient brought in by neighbor or friend Receptionist takes the history

HISTORY?

Human Error Lack of familiarity with the anesthetic

machine or drugs Thank goodness for LVTs!

Human Error

Fatigue Scheduling of surgeries can help with this

Distracted or rushed Usually you have your surgical patient and…

Inattentiveness Having a low level of anxiety is good!

Human Error Incorrect administration of drugs

Inaccurate weight Units, scale is off

Math errors – calculating OR drawing up Use of wrong medication Use of wrong concentration

Enro, ketamine, dexmed, pred Incorrect route of administration

IV v. IM

Confusion between syringes*ALWAYS LABEL SYRINGES

Equipment Failure

CO2 ABSORBER EXHAUSTION

How is CO2 removed from a rebreathing system?

How is CO2 removed from a non-rebreathing system?

Best way to keep an eye on exhaled CO2?

↑ CO2 = Tachypnea, tachycardia, brick red mucous membranes, cardiac arrhythmias

Equipment Failure

NO OXYGEN FLOW Which two parts of the machine may be malfunctioning?

Flow meter: will gradually fall as the O2 tank empties Periodically check this!

Oxygen tank: check for empty tank, disconnected hose, leaks

*Which breathing system can go without O2 flow longer?

Equipment Failure

ANESTHETIC MACHINE MISASSEMBLED The better you know this machine and the flow of

gas, the quicker you will be able to solve problems.

*Where do you think the most common misassembled part happens on the machine?

Equipment Failure ENDOTRACHEAL TUBE PROBLEMS

Blocked tube Twisting or kinking of the tube (inappropriate

positioning) Accumulation of material such as blood, mucus,

excess lubricant*What tubes do you need to pay special attention to?

Blocked tube decreased oxygen to patient

How would this scenario lead to cardiac arrhythmias?

Solution: Check signs of tube properly in the trachea If truly blocked extubate or suction with RRC

Equipment Failure

ENDOTRACHEAL TUBE PROBLEMS

Tube advanced too far into a bronchus

How do you solve this?

Cuff or tube is damaged Solution?

Equipment Failure

VAPORIZER PROBLEMS Wrong anesthetic in the vaporizer

Solution:

Tipped over or over-filled Solution:

Vaporizer dial may be jammed Solution:

Equipment Failure

POP-OFF VALVE PROBLEMS The pop-off valve is inadvertently left closed

Two reasons why pop off would be left closed?:

Solution: open the pop-off valve and/or decrease the oxygen flow rate.

*Can adjust the amount of gas in the reservoir bag by adjusting the pop off valve

Anesthetic Agents

“Every injectable or inhalation agent has the potential to harm a patient and, in some cases, cause death”. (Page 323)

Review the description of the physiological effects of pre-anesthetic and general anesthetic agents in chapter 3.

Anesthetic protocol should be chosen based on the patient’s needs

Anesthetist must be familiar with side effects Such as?

Why is balanced anesthesia safer?

Patient Factors

Trauma Age Weight Breed Organ disease

Urinary obstruction

Patient Factors TRAUMA PATIENTSPhysical Status Classification= P3, P4 or P5

Potential Problems:Respiratory distress

Pneumothorax/Pleural effusion: No negative pressure or fluid compressing lung

expansion

Pulmonary contusions/edema: fluid in lung parenchyma No gas exchange

FLUID SHOULD BE REMOVED BEFORE ANESTHESIA*What therapy might we want to provide while patient is stabilizing?

Patient Factors

TRAUMA PATIENTSPotential Problems:

Cardiac arrhythmias What drug should you have on hand and know

the dose for?

Shock, hemorrhage What fluids might you prep?

Fractures/organ rupture anemia Unknown internal injuries

Patient Factors

TRAUMA PATIENTS Solutions:

Stabilize patient- may be hours to daysdecrease anesthetic risk!

Obtain rads, ECG, blood work