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Anesthesia Complications

Adminstration of anesthesia is a complex task. Anyone receiving anesthesia must be monitored continuously to protect and maintain vital body functions.

Generally, with proper care and vigilant monitoring, complications are rare. However,  permanent injury or death can result from anesthesia errors. 

A reported $1.88 million in excess cost for complications of anesthesia was attributable to patient safety incidents in the US 2000-2002 (Patient Safety in American Hospitals, Health Grades 2004).

There are many different forms of anesthetic administration. The type of anesthesia which is used may be determined by the anesthesia care provider and/or surgeon, and may be based on the extent and duration of the surgical procedure to be performed, as well as a patient’s medical risk factors.

Local anesthesia is used in minor surgical procedures and involves numbing a small area by injecting a local anesthetic under the skin just where an incision is to be made. When used alone, this type of anesthesia has the least number of risks and when used properly, local anesthetics are safe and have few major side effects. However, when local anesthetics are used in high doses, they can have toxic effects if they are absorbed through the bloodstream into the rest of the body. This can result in complications associated with breathing, heartbeat, blood pressure, and other body functions. Because of these potential toxic effects, equipment for emergency care must be immediately available when local anesthetics are used.

Sedation may be used to produce "twilight sleep", and is often used when the duration of the procedure is anticipated to be short, when general anesthesia is not necessary, or when a patient’s medical risk factors preclude administration of general anesthesia. Sedation is commonly used during dental procedures, endoscopic procedures, and some pain management procedures. The effect of sedation produced by an IV medication or combination of IV medications can affect a patient’s respiratory rate and heart rate so it is important that a trained healthcare provider be designated to monitor the patient’s vital signs during the procedure. Emergency equipment must be immediately available in the event of an adverse reaction to sedative medications.

Regional anesthetics involve injection of local anesthetic around nerves or the spinal cord to block pain. Often, sedation is used in combination with regional anesthetics. Major types of regional anesthesia include epidural or spinal anesthesia, used to block pain from an entire region of the body such as the abdomen and peripheral nerve blocks used to block pain near a specific nerve or group of nerves in the hands, arms, feet, legs or face.

General anesthetics are used to produce an unconscious state and are used for major surgical procedures. Anyone receiving general anesthesia must be monitored continuously to protect and maintain vital body functions. The complex task of managing the delivery of anesthesia medications and monitoring vital functions must be performed by trained anesthesiologists and certified nurse anesthetists. Most adults are first anesthetized with liquid intravenous anesthetics followed by anesthetic gases after they are asleep. In children, the anesthesiologist may use anesthetic gases administered through a mask to induce sleep, since children often do not like having an intravenous catheter placed while they are awake.  During general anesthesia, patients must be carefully monitored for heart rate and rhythm, blood pressure, oxygen saturation and ventilation, and the anesthesia specialist must be able to rapidly recognize and manage significant changes in vital signs in order to prevent complications.

When the surgery is over, the goal is to wake the patient up if sedation or general anesthesia has been used, or to wait a sufficient time until local or regional anesthetics have worn off.  In cases where a patient does not wake up from anesthesia, or where there has been a serious change in a patient’s condition, a full evaluation of the patient’s medical records is recommended.

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