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Anesthetic Risks

Anesthetic Risks. รศ.นพ.เทพกร สาธิตการมณี หัวหน้าภาควิชาวิสัญญีวิทยา คณะแพทยศาสตร์ มหาวิทยาลัยขอนแก่น. Causes of Anesthetic Risks. Man Knowledge Skills Vigilance / Negligence Teamwork / Holistic Anesthetists & Surgeons Treat underlying diseases

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Anesthetic Risks

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  1. Anesthetic Risks รศ.นพ.เทพกร สาธิตการมณี หัวหน้าภาควิชาวิสัญญีวิทยา คณะแพทยศาสตร์ มหาวิทยาลัยขอนแก่น

  2. Causes of Anesthetic Risks • Man • Knowledge • Skills • Vigilance / Negligence • Teamwork / Holistic • Anesthetists & Surgeons • Treat underlying diseases • HT, DM, Electrolyte imbalance, Volume status

  3. Causes of Anesthetic Risks • Materials • Standard : EKG, Pulse oximeter, NIBP, Capnograph • Adequacy : Spare units • Routine check-up before each case • Preventive maintenance & Calibration • Pay attention to any alarms • Do not suspend alarms

  4. Causes of Anesthetic Risks • Management • Risk Management • Incident Report • M&M Conference • Practice Guidelines • CQI & TQM

  5. Anesthetic Risks • GA vs. RA • Equivalent risks • GA • Airway management • Aspiration • Drugs side-effects & Interactions

  6. Anesthetic Risks • RA • Bezold-Jarisch reflex (severe bradycardia – hypotension – cardiac arrest) • High block  Total spinal block • Hypotension, bradycardia, cardiac arrest • Respiratory insufficiency  Apnea • Inadequate block • Light sedation : Never heavy sedation • GA • Systemic toxicity of local anesthetics • Convulsion  Apnea  CVS depression  Cardiac arrest • Neurological deficit

  7. Safety Rules • There is Minor Surgery  but no Minor Anesthesia • Pre-operative preparation • Standard for all • NPO time : always strict to the rule • Good teamwork • No compromise

  8. Safety Rules • Intra-operative • Always communicate • Alert & Vigilance • No negligence • Avoid drug errors

  9. Safety Rules • Post-operative • Extubate ??? • Ventilate ??? • Appropriate assessment • Extubation/Ventilation Criteria • Day or Night • ASA Classification • Pre-operative risk factors • General or Private ward • If ambiguous : Over-treatment > Under-treatment

  10. The End Thank you for your attention  Q & A

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