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Open Access | Published: 2021 - Issue 1

AN OVERVIEW ON ANESTHESIA INTERVENTIONS THAT ALTER POSTOPERATIVE COMPLICATIONS AND MORTALITY

Mohammed Saleem Alsofiany1*, Faisal Abdulmohsen Aljuaid1, Fehaid Mohammed N Alghtani2, Matab Mohammed Bushnag3, Nashmi Naife Al-Jubairi4, Ghassan Hussain Alsinan5, Norh Ahmad Almodehash6, Faris Saleh Mohammed7, Zaid Alawi Alotaibi8, Ahmed Mohammad Alazwari9, Mohammed Abdullah Al Khalaf 10

 

  1. Faculty of Medicine, Taif University, Taif, KSA.
  2. Anesthesia Department, King Salman Hospital, Riyadh, KSA.
  3. Faculty of Medicine, King Abdulaziz University, Jeddah, KSA.
  4. Faculty of Medicine, Almajma’ah University, Riyadh, KSA.
  5. Faculty of Medicine, University of Warmia and Mazury, Olsztyn, Poland.
  6. Faculty of Medicine, King Saud University, Riyadh, KSA.
  7. Faculty of Medicine, King Khalid University, Abha, KSA.
  8. MBBS, Department of Emergency Medicine, Al Iman General Hospital, Riyadh, KSA.
  9. FaFaculty of Medicine, Imam Mohammed Bin Saud Islamic University, Riyadh, KSA.
  10. Faculty of Medicine, Vision Colleges, Riyadh, KSA

ABSTRACT

The occurrence of anesthetic complications postoperatively is not unique. However, some anatomical and physiological change takes place after surgical procedures. Managing surgical patients remain challenging in different aspects and stages of hospital management. Morbidity and mortality that occurs postoperatively under incorrect dosing and administration are common for anesthesiologists injecting up to half a million medication throughout their profession. The expectancy and chances of committing errors are unpredictable and tragic. This review will guide anesthesiologists to modify new clinical skills that will aid their evaluation upon dealing with anesthetic complications. This literature review aims to examine and discuss the most undesirable complications categories and mortality rates after anesthetics administration. This review was obtained using an electronic-based search engine along with Google Scholar and PubMed. Anesthesiologists need to describe the complications in a categorized form, to clarify the anesthetics hazards as clear as possible. This will result in a better outcome for any at risk patients and make the intervention much quicker and precise.

Keywords: Anesthesia complications, Mortality, Epidemiology, Medication errors


Introduction

Managing surgical patients remain challenging in different aspects and stages of hospital management. “How are we prepared to overcome any complications of anesthesia?” question is often asked among the anesthetists’ team. Several reasons are determining why anesthetists must be able to answer these questions. An anesthetist trainee is expected to be able to respond and master ways to avoid and overpower these types of controversial questions, however, it seems that it is quite tough to answer this question [1].

Some of the earliest notable effects of anesthesia postoperatively, and were managed in critical care such as airway and renal complications. Other devastating complications are associated with cardiovascular and cognitive dysfunction [2, 3]. Central and peripheral neurological systems-related injuries have not been always a field of interest in anesthesiology, and it is argued that neural function is practically ignored especially in the perioperative period [2].

The impact of anesthetic medication needs attention as errors are a major issue after anesthetic administration. Morbidity and mortality that occur postoperatively under incorrect dosing and administration are common for anesthesiologists injecting up to half a million medications throughout their profession. The expectancy and chances of committing errors are unpredictable and tragic [4].

This literature review aims to examine and discuss the most undesirable complications categories and mortality rates after anesthetics administration. Moreover, this review will guide anesthesiologists to modify new clinical skills that will aid their evaluation upon dealing with anesthetic complications. In addition, it will focus and participate to maintain a safe workplace for managing patients undergoing anesthesia.

Materials and Methods

This is overview research concluding all topics related to the complications and mortality in anesthesia within the periods of 1954 up to 2018. This review was obtained using an electronic-based search engine along with Google Scholar and PubMed. Published researches written in English and English translated researches were only collected to be analyzed in this review. Only related articles, documents, clinical trials, and reviews were included in this research. The search used a combination of these keywords on MESH and these terms were included: (( “Anesthesia” [Mesh] “Mortality”[Mesh] “Complications” [Mesh] “History” [Mesh] “Incidence” [Mesh] “Definition” [Mesh] “Medication” [Mesh]AND “Errors” [Mesh])).

Review

Anesthesia Worldwide Burdens

For many decades anesthesia mortality risks have been an intense research field. Between the periods of 1948 and 1952, ten academic medical centers and 599,500 surgical patients were studied in the United States to assess the deaths preceding anesthesia and surgery. The death rate reached up to 64 deaths upon every 100,000 procedures under anesthetic agents, patient health characteristics, and health provider types. The number of deaths reached up to 5100 or 3.3 per 100,000 populations. The number of deaths exceeded poliomyelitis at that time [5, 6].

The 1954 report helped in identifying and marking anesthesia safety measures as an existing health issue. This had a greater chance in inspiring and improving new anesthesia techniques, training administration methods, drugs. Therefore, the mortality rate associated with anesthetic procedures has declined from 1 in 1000 deaths in the late 1940s to 1 in 100,000 in the early 2000s [5, 7].

As postoperative pulmonary complication is an aggravating problem in vascular and abdominal surgeries, the rates in patients who are considered at risk increased up to 40% [8, 9].  Unlike patients being at risk and does not undergo cardiac or obstetric surgery, rates were up to 14.5%. Generally, a severe pulmonary complication occurs in about 2.8% of all cases undergoing general anesthesia [9, 10].

The mortality rate that is noticeable on acute renal injury after anesthesia often reaches up to 46%. Renal injury complicates hospital admissions up to 20%. It complicates surgical procedures approaching 30 – 40% of hospital perioperative acquired acute kidney injuries [11].

Several case reports and prospective studies were done to estimate the incidence of medication errors. The results in these prospective studies showed that the medications errors rate has not changed throughout 15 years, with a fixed rate that ranges between 0.33% and 0.73%. Errors upon medical events have been reported by a critical care safety study, where 80.5 medications were bound to harm nearly thousands of patients during medical or coronary care. The most-reported drugs included popular cardiac stimulants, opioids, and vasopressors [4].

Defining Anesthesia Complications and Associated Clinical Events

When deliberating the complications of anesthesia, the idea of unfavorable events applies very well to a future context regarding critical and usual postoperative conditions. The occurrence of anesthetic complications postoperatively is not unique. However, some anatomical and physiological change takes place after surgical procedures. This reflects upon the activity and response of the patient to the improvement process. Table 1 below describes the complications in a categorized form, to clarify the anesthetics hazards as clear as possible [1].

Table 1. Anesthetics hazards defined by systems, categories, events, consequences, and contributing factors [1]:

Systems and related categories

Associated events

Undesired consequences

Complications contributing factors

Lower airway tract

Tracheal intubation difficulties

Soft tissue injury

Dental injury

Hypoxia

Not enough experience

Airway difficulties

Urgencies

Difficulties in incubation

Oxygenation obstacles

Airway injury

Hypoxia

Surgical injury

Surgical delay

Sudden death

Inaccurate assessment of the airway

Respiratory system

Airway subjected to high pressures

Pneumothorax

Pulmonary barotrauma

Incomplete muscle relaxation

Overweight

Pneumoperitoneum

Bronchospasm

Endotracheal tube placement

Hypoxia

Unable to do chest auscultation

Lack of experience

Aspiration

Pneumonitis

Ventilation is prolonged

Reflux might occur

Patient might not be fasting

Lung injury by needles

Pneumothorax

Central line insertion difficulties

Lack of experience

Cardiovascular

Hypotension

Sudden arrest

Ischemia

Brain injuries

Hemorrhage

Sepsis

Hypovolemic shock

Neuraxial block

Hypertension

Hemorrhage

Stroke

Aneurysmal or anastomosis rupture

Twilight sedation

Incompetent analgesia

Awareness

Central nervous system

Post Dural punctures

Postural headaches

Spinal or epidural difficulties

Lack of experiences

Misplaced epidural catheterization

Post-or intraoperative pain

Prolonged surgery

Lack of experiences

Procedure obstacles

Epidural vessels damage

Paraplegic epidural hematoma

Coagulopathies

Anticoagulation

Bleeding disorders

Unable to turn the vapouriser on

Psychological traumas

Awareness

Distractions

Comorbidity

Surgeries of high risk

Peripheral nervous system

Intra-neural injections

Injury of the peripheral nerve

Pain and weakness

The patient is positioned incorrectly

Lack of experience

Drug-related

Allergic reactions

 

Anaphylaxis

Patient-related factors

Insufficient history taking information

Adverse drug reactions

Malignant hyperthermia

Patient-related factors

Insufficient history taking information

Error in drug administration

Neuromuscular blockade Hypertension

Inaccurate labeling

Lack of attention

Distractions

Intravenous line infiltration

Absence of drug effect

Access difficulties

Insert in situ lines from the ward

 

Conclusion

For many decades, anesthesia mortality risks have been an intense research field. Identifying and marking anesthesia safety measures as an existing health issue has a greater chance of inspiring and improving new anesthesia techniques, training administration methods, drugs. The occurrence of anesthetic complications postoperatively is not unique. However, some anatomical and physiological change takes place after surgical procedures. This reflects upon the activity and response of the patient to the improvement process. Anesthesiologists need to describe the complications in a categorized form, to clarify the anesthetics hazards as clear as possible. This will result in a better outcome for any at-risk patients and make the intervention much quicker and precise.

Acknowledgments: None

Conflict of interest: None

Financial support: None

References

1.     Merry AF, Mitchell SJ. Complications of anaesthesia. Anaesthesia. 2018;73 Suppl 1:7-11.

2.     Mashour GA, Woodrum DT, Avidan MS. Neurological complications of surgery and anaesthesia. Br J Anaesth. 2015;114(2):194-203.

3.     Lankhorst S, Keet SW, Bulte CS, Boer C. The impact of autonomic dysfunction on peri-operative cardiovascular complications. Anaesthesia. 2015;70(3):336-43.

4.     Dhawan I, Tewari A, Sehgal S, Sinha AC. Medication errors in anesthesia: unacceptable or unavoidable? Braz J Anesthesiol. 2017;67(2):184-92.

5.     Li G, Warner M, Lang BH, Huang L, Sun LS. Epidemiology of anesthesia-related mortality in the United States, 1999-2005. Anesthesiology. 2009;110(4):759-65.

6.     Beecher HK, Todd DP. A study of the deaths associated with anesthesia and surgery: based on a study of 599, 548 anesthesias in ten institutions 1948-1952, inclusive. Ann Surg. 1954;140(1):2-35.

7.     Dripps RD, Lamont A, Eckenhoff JE. The role of anesthesia in surgical mortality. Jama. 1961;178:261-6.

8.     LAS VEGAS investigators. Epidemiology, practice of ventilation and outcome for patients at increased risk of postoperative pulmonary complications: LAS VEGAS - an observational study in 29 countries. Eur J Anaesthesiol. 2017;34(8):492-507.

9.     Mills GH. Respiratory complications of anaesthesia. Anaesthesia. 2018;73 Suppl 1:25-33.

10.  Gupta H, Gupta PK, Fang X, Miller WJ, Cemaj S, Forse RA. Development and validation of a risk calculator predicting postoperative respiratory failure. Chest. 2011;140(5):1207-15.

11.  McKinlay J, Tyson E, Forni LG. Renal complications of anaesthesia. Anaesthesia. 2018;73 Suppl 1:85-94.

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