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risk assessment Flashcards

1
Q

1st anesthetic

A

1846 (ether)

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2
Q

1st death from anesthesia

A

(chloroform) 1848

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3
Q

1st study

A

(John Snow, chloroform) 1858

•50 deaths; healthy pts, minor procedures

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4
Q

•Risk (noun)

A
  • Hazard, danger, exposure to peril
  • 1:1000
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5
Q

•Risk (verb)

A

•To expose to the chance of injury or loss

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6
Q

Perioperative Risk

A
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7
Q

•Technical/Systems (periop risk)

A
  • Information data systems
  • Appropriateness of postoperative monitoring
  • Specialized nurses/equipment
  • Staffing patterns
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8
Q

•Anesthetic Management- risk

A

Technical difficulties with airway management

  • Risks of positioning
  • Choices of anesthetic
  • Postoperative extubation

Pain management

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9
Q

Medical Factors

A
  • Do not depend on practice location or anesthetic technique
  • Patient medical condition
  • Well described for some factors/not for others
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10
Q

Perioperative Risks of surgery itself

A
  • Severity of surgical procedure
  • Well based in research
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11
Q

Goals of Risk Assessment

A

Accurately assess potential risk

  • Emergent
  • Elective
  • “Grey-zone”

Identify modifiable risk factors

  • Coronary revascularization prior to non-cardiac surgery
  • CEA prior to……
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12
Q

History of Risk Assessment

A

•ASA 1941

Calculation of overall operative risk “useless”

  • Too much variety in patients health
  • Varying severity of planned procedure
  • Varying familiarity of hospitals with procedure
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13
Q

ASA Physical Status

A

1 Healthy patient without medical problems

2 Mild, well-controlled systemic disease

3 Severe systemic disease (not incapacitating)

4 Severe systemic disease (constant threat to life)

5 Moribund (not expected to live 24 hours regardless of procedure)

6 Organ donor

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14
Q

ASA Physical Status Examples

A
  • 1 Healthy, non-smoker, minimal alcohol
  • 2 smoker, pregnancy, obesity (BMI<30), well controlled DM, mild lung dz
  • 3 poorly controlled DM, HTN, COPD, alcoholism, CAD, >3mo hx MI/CVA
  • 4 <3mo hx of MI/CVA, ESRD on dialysis, DIC
  • 5 Ruptured thoracic aneurysm, massive trauma, MODS
  • E: emergency
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15
Q

John Hopkins Risk System

A
  • 1 Minimally invasive; little to no blood loss; office setting. Minimal risk
  • 2 Minimally/moderate invasive; blood loss <500ml. Mild risk
  • 3 Moderate/significantly invasive; blood loss 500-1500ml; Moderate risk
  • 4 Highly invasive; blood loss >1500ml; Major risk
  • 5 Highly invasive; blood loss >1500ml; Critical risk; ICU postop
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16
Q

Limitations of risk systems

A
  • ASA doesn’t consider operative procedure
  • John Hopkins doesn’t consider physical health; estimates difficulty
  • Neither considers anesthetic difficulty
17
Q

Maternal Mortality:
anesthetic implications

A
  • More difficult airway
  • Emergency induction
  • Suboptimal preparation/examination
  • Failed regional/contraindicated regional
  • Poor residency training
18
Q

Jehovah’s Witnesses

A

•Blood/blood products outlawed in 1945

“That ye abstain from meats offered to idols, and from blood, and from things strangled, and from fornicaton: from which if ye keep yourselves, ye shall do well.” Acts 15:29

•Guidelines

Private conversation

What if you were dying?

Court order?

In an emergency?

Perioperative blood work?

19
Q

Blood components

A
20
Q

focused risk assessment examples

A

inadequate mask ventilation

acute renal failure in normal CrCl

21
Q

Pediatric Mortality

A

Greatest risk

  • Very young
  • Non-pediatric facilities- less eqiupment- not more risk
22
Q

Pediatric Anesthetic Implications

A
  • Tongue large
  • Glottis anterior
  • Less pulmonary reserve
  • Neonatal hearts non-compliant
23
Q

Breastfeeding risks

A

Past- any drug gave mom appeared in breast milk; pump and dump 24 hrs

Current- safe to breastfeed immediately

-Safe pain meds

  • Protein bound? Colostrum doesn’t have much protein (won’t hang on to drugs
  • Volume of distribution? Really large Vd in mom so not so much for breast milk
  • Colostrum/breast milk: Colostrum doesn’t have much protein (won’t hang on to drugs
24
Q

Improving safety

A
  • APSF October 1985
  • Standards

Unanimous decision to choose

Intraoperative Monitoring

•Guidelines

Followed in most cases….tailored to individual

Difficult airway algorithm

Surgical time-out

Use of blood components

25
Q
A

Assessment (8 decks)

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