Anaesthetic and Perioperative Complications

274 Pages·2011·4.24 MB·English

by  K. Valchanov

Anaesthetic and
Perioperative Complications

Anaesthetic and
Perioperative
Complications
Edited by
Kamen Valchanov
Consultant in Anaesthesia and Intensive Care at Papworth Hospital NHS Trust, Cambridge, UK
Stephen T. Webb
Consultant in Anaesthesia and Intensive Care at Papworth Hospital NHS Trust, Cambridge, UK
Jane Sturgess
Consultant Anaesthetist at Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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© Cambridge University Press 2011
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First published 2011
Printed in the United Kingdom at the University Press, Cambridge
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Library of Congress Cataloguing in Publication data
Anaesthetic and perioperative complications / [edited by] Kamen Valchanov, Stephen T. Webb,
Jane Sturgess.
p. ; cm.
Includes bibliographical references and index.
ISBN 978-1-107-00259-3 (hardback)
1. Anesthesia – Complications. 2. Anesthetics – Side effects. I. Valchanov, Kamen.
II. Webb, Stephen T. III. Sturgess, Jane.
[DNLM: 1. Anesthesia – adverse effects. 2. Perioperative Care – adverse effects. WO 245]
RD82.5.A57 2011
617.96–dc23 2011020617
ISBN 978-1-107-00259-3 Paperback
Cambridge University Press has no responsibility for the persistence or
accuracy of URLs for external or third-party internet websites referred to in
this publication, and does not guarantee that any content on such websites is,
or will remain, accurate or appropriate.
Every effort has been made in preparing this book to provide accurate and up-to-date information
which is in accord with accepted standards and practice at the time of publication. Although case
histories are drawn from actual cases, every effort has been made to disguise the identities of the
individuals involved. Nevertheless, the authors, editors and publishers can make no warranties that
the information contained herein is totally free from error, not least because clinical standards are
constantly changing through research and regulation. The authors, editors and publishers therefore
disclaim all liability for direct or consequential damages resulting from the use of material contained
in this book. Readers are strongly advised to pay careful attention to information provided by the
manufacturer of any drugs or equipment that they plan to use.
Contents
Foreword by Professor Alan Merry vii
List of contributors ix
List of abbreviations xi
Section 1 Generic aspects of 9 Perioperative neurological
complications 93
complications
Nick Lees and Andrew A. Klein
1 Preventing complications 1 10 Hepatic, renal and endocrine
Jane Sturgess complications 107
2 Managing complications 10 A. James Varley and Fay J. Gilder
Kamen Valchanov and Alistair Steel 11 Injury during anaesthesia 119
3 Risk management 18 David Bogod and Kasia Szypula
Mark Dougherty and Stephen 12 Regional anaesthesia
T. Webb complications 130
Tim M. Cook and Mike Coupe
Section 2 Clinical aspects of
13 Body temperature complications 153
complications
John Andrzejowski and James Hoyle
4 Airway complications during 14 Equipment malfunction 165
anaesthesia 23 Rajinikanth Sundararajan and Peter
Nick Woodall and Helen Goddard Faber
5 Respiratory complications 43 15 Drug reactions 175
Andrew Roscoe and Hamish Alison Kavanagh and Martin Shields
Thomson
16 Management of postoperative
6 Cardiovascular complications 54 complications 187
Victoria Howell and Joseph Benias Mugabe and Saxon Ridley
E. Arrowsmith
Section 3 Ethical and
7 Complications of blood products
and fluid infusions 70 medico-legal complications
Dafydd Thomas and Tom Holmes
17 Before complications occur:
8 Complications during obstetric Assessing, balancing and explaining
anaesthesia 81 risk; Consent 201
Felicity Plaat and Matt Wilkner Derek Duane
v
vi Contents
18 After complications occur: 20 Management of complaints and
Explaining complications and litigation in the UK 232
outcome; Allocating blame; Jane Sturgess and Sam Bass
Implications for the hospital and the
anaesthetist 210 21 The role of the expert witness 241
Jurgens Nortje
Aoibhin Hutchinson and Clare Bates
19 Risk factors for litigation 221
Dominic Bell Index 248
Foreword
William T. G. Morton’s celebrated demonstration of ether, in Boston, took place in 1846.
Very little time elapsed before the first reported death under anaesthesia occurred, that
of 15 year old Hannah Greener who was given chloroform for the removal of an infected
ingrowing toenail. Of course, the horror of facing the surgeon’s knife without anaesthesia
was clearly appreciated by patients at that time, so the contribution of modern anaesthesia
to improving the lot of mankind was understood. This contribution was encapsulated in
Morton’s epitaph:
Inventor and Revealer of Anaesthetic Inhalation
Before Whom in all time Surgery was Agony
By Whom Pain in Surgery was Averted and Annulled
Since Whom Science has control of Pain
Furthermore the risks of surgery in the first two thirds of the 19th century were very high (in
part because the importance of antisepsis had not yet been realised), so the balance between
the benefits of anaesthesia and its potential risks was acceptable. Since then, the safety of
both surgery and anaesthesia has been transformed, but so have the expectations of the
public. Progress in anaesthesia has substantially revolved around minimizing and mitigat-
ing the risk of complications associated with the perioperative care of patients undergoing
surgery, but as the absolute incidence of these complications has reduced, the expectations
for measures to avoid them, and for expertise in managing them when they occur, have
grown exponentially. Today’s patients expect very high standards of care, particularly when
things do go wrong. Part of this expectation arises from the fact that anaesthesia today is
very safe in fit patients undergoing routine procedures in most high-income countries of
the world. However, the truth is that even in these circumstances complications occur from
time to time, sometimes with tragic consequences for patients and often also with serious
implications for the staff involved in their care. When patients are very young or very old, or
have serious co-morbidties, or are undergoing major surgery, the risks are much increased.
The situation in some of the less wealthy parts of the world is also much more concerning:
Reports suggest that the rate of mortality associated with anaesthesia in parts of Africa (for
example) is orders of magnitude higher than in the UK (also for example). Anaesthetic and
Perioperative Complications is therefore a timely and important contribution to the cause of
patient safety.
The strengths of Anaesthetic and Perioperative Complications are several. It is clearly and
accessibly written. It is sufficiently comprehensive to meet the needs of most busy practition-
ers without overburdening them with excessive detail. The layout of the book is structured in
a way that will make intuitive sense to clinical anaesthetists. And it is written predominantly
by practising anaesthetists, including several trainees. This book is not by or for the ivory
tower theorist: It is a practical guide by and for clinical anaesthetists at every stage of their
career.
The first section of the book provides a brief introduction to the elements of human
error and the principles underlying the mitigation of risk, the prevention of complications,
and the management of patients when things actually do go wrong. This equips the reader
to place the body of the book into context. In the second section, the complications typically
vii
viii Foreword
associated with anaesthesia are reviewed and discussed. Anaesthetists will intuitively under-
stand the framework of this section: Complications are grouped around airways, the respira-
tory system, the cardiovascular system, the use of blood products, the administration of
drugs, the use of equipment, the provision of obstetric anaesthesia, and so on. These chapters
should be mandatory reading for every trainee. For experienced anaesthetists they provide
a useful summary of contemporary information about complications related to various
aspects of clinical anaesthesia. The third section of the book addresses ethical, legal and
practical aspects of complications in anaesthesia. Understanding and managing these mat-
ters is a central part of modern anaesthesia, and competency in this area is to be expected of
clinicians in all fields of healthcare today.
The editors, Kamen Valchanov, Stephen Webb and Jane Sturgess, have produced a prac-
tical and readable book. The ultimate beneficiaries of their work will be the patients whose
outcomes will certainly be improved when they are cared for by anaesthetists who have read
it, assimilated its information, and put its key messages into practice.
Professor Alan Merry