INCIDENTS-ACCIDENTS IN GENERAL ANESTHESIA
Anesthesia allows surgical, obstetrical or medical procedures (endoscopy, radiology, etc.) to be performed, eliminating the pain caused during and reducing it after the procedure under optimal safety conditions.
There are two main types of anesthesia: general anesthesia and regional anesthesia.
General anesthesia is a state similar to sleep, produced by the injection of medication through an IV, and/or by breathing. Thus, general anesthesia makes you lose consciousness while the procedure is being performed.
Any medical procedure, even when carried out competently and in compliance with acquired scientific data, involves a risk.
Current conditions for monitoring anesthesia and the recovery period make it possible to quickly detect the occurrence of anomalies and treat them.
Also, serious complications of anesthesia, whether cardiac, respiratory, neurological, allergic or infectious, have become very rare.
Complications of anesthesia are divided into two groups: minor complications (or incidents), which are frequent and most often without consequences, and major complications (or accidents), which are rarer.
I. MINOR COMPLICATIONS (INCIDENTS) OF GENERAL ANESTHESIA
- Nausea and vomiting : up to 30% of patients; morphine, type of anesthesia (emetogenic action of halogenated nitrous oxide, etc.), type of surgery (ENT++), pain, stress, hypoxia, hypovolemia, female gender, history of motion sickness, history of NVPO (postoperative nausea and vomiting) are implicated
They have become much less frequent in recent years with the latest anesthetic measures (eg: antiemetic effects of Propofol).
- sore throat or hoarseness : after the procedure, these are generally linked to intubation.
- Dental trauma : is also possible. It is important to report any prosthesis or any particular dental fragility during the consultation.
- Posture-related complications related to prolonged position on the operating table which can cause nerve compressions with numbness or, exceptionally, paralysis of an arm or leg.
Half-sitting position: major risk of gas embolism, collapse, compression of the sciatica, elongation of the brachial plexus.
They must be prevented by careful installation before starting the surgery,
- Memory problems or decreased ability to concentrate may occur in the hours following anesthesia.
After general anesthesia, memories of the operative period may remain.
-All the symptoms mentioned above are usually temporary and their persistence should prompt you to consult.
II. MAJOR COMPLICATIONS (OR ACCIDENTS) OF GENERAL ANESTHESIA
Unpredictable life-threatening complications such as severe allergy, cardiac arrest, asphyxia are extremely rare.
- RESPIRATORY COMPLICATIONS
These are the most common complications and the leading cause of death.
Inadequate ventilation is the cause in 1/3 of cases, most often during induction, more rarely during or after surgery.
The problem may come from the anesthesia, the surgery or the patient. The consequence in all cases is hypoxia.
Advanced age, chronic respiratory failure, obesity, sleep apnea syndrome, gastroesophageal reflux disease (GERD) and a full stomach are serious factors. The most common causes of hypoxia are:
- Respiratory depression+++, often of drug origin (residual curarization, morphine, hypnotics to a lesser extent).
- Inhalation and Mendelson’s Syndrome: Accidents related to the passage of vomit into the lungs are very rare if the preoperative fasting instructions are followed carefully.
It is usually recommended not to eat anything for 6 hours before anesthesia. Up to two hours before anesthesia, it is allowed to drink water, or fruit juice without pulp.
In addition to a full stomach, the risk is higher in cases of GERD, pregnancy, or in certain predisposing conditions (diabetic gastroparesis+++).
There are many other causes of hypoxia:
- upper airway obstruction+++ (tongue drop, glottic edema , bronchospasm, laryngospasm),
- pneumothorax, atelectasis, pulmonary embolism , etc.
- technical problem
INCIDENTS-ACCIDENTS IN GENERAL ANESTHESIA
-Ventilation and/or intubation impossible
-Unrecognized esophageal intubation,
– Respirator problem, hypoxic gas mixture
These complications resolve spontaneously or with well-conducted treatment but are potentially fatal if they are not detected in time.
Respiratory complications are the most common. They are very often related to the anesthetic agents that cause apnea and hypoventilation. They may be due to the impossibility of intubating or ventilating. They are aggravated by the patient’s history and the type of surgery. They are minimized by a good preoperative assessment.
- CARDIOVASCULAR COMPLICATIONS
They are uncommon (1 to 2%), but are life-threatening.
The most common complications are myocardial ischemia and infarction (MI), heart failure and rhythm disturbances. Hypotension (hypoBP) or even intraoperative collapse is most often the cause.
- Moderate hypoBP is common, especially at anesthesia induction. The causes of arterial hypotension are multiple:
-vasoplegia for most anesthetic agents,
– shock states (hemorrhagic, cardiogenic, septic, anaphylactic),
– postural or surgical discomfort in venous cava return,
-cardiac causes: heart failure, myocardial ischemia, rhythm and conduction disorders, tamponade.
b) Rhythm and conduction disorders:
-ischemic myocardial suffering,
-hypoxia, hypercapnia, hypothermia, ionic or acid-base disorders,
-effects of certain anesthetic agents, drug interactions.
- High blood pressure (HBP) : hypercapnia, superficial anesthesia, discontinuation of HBP treatment.
- Acute pulmonary edema : volume overload, decompensation of left ventricular failure.
- Cardiocirculatory arrest : most often of hypoxic origin.
Cardiac complications are rare but potentially fatal; they are much more frequent in cases of recent infarction.
Hypotension is common, related to anesthetic agents and hypovolemia. It must be quickly controlled.
Myocardial ischemia is difficult to detect and must be prevented by optimizing oxygen supply and transport.
- NEUROLOGICAL COMPLICATIONS
These are mainly strokes , it is most often very difficult to attribute them directly and solely to well-conducted anesthesia. On the other hand, it is much more common to be confronted with peripheral neurological lesions due to poor postural positioning during anesthesia.
- ALLERGIC COMPLICATIONS
They are the ones that patients fear the most. They are rare (1/13,000).
Anaphylactic shock represents the most serious manifestation of immediate hypersensitivity: Serious disturbance of circulatory homeostasis induced by the introduction into the body of a foreign substance responsible for immunological reactions,
Allergy to curare is the most common, followed by hypnotics and morphine, then latex and antibiotics. A first sensitizing contact is not mandatory.
Risk factors are: a history of anesthetic accident, a latex allergy, atopy, certain food allergies.
Treatment Correction of shock => intravenous adrenaline plus filling
Prevention of its recurrence => mandatory allergy investigation.
- OTHER COMPLICATIONS
- Malignant hyperthermia : This is a rare complication triggered by inhaled halogenated anesthetic agents (HAAs) and suxamethonium iodide (Celocurine®), in genetically predisposed subjects.
It requires rapid and precise management to try to control the core temperature, with essential pharmacological support: dantrolene (Dantrium®).
- Hepatitis : with AAH, which has become exceptional with new molecules.
- Shivering : due to post-op hypothermia. This must be corrected before waking up, it is harmful for patients with coronary artery disease and respiratory failure.
- Hypothermia : delayed awakening, cardiac rhythm disorders, primary hemostasis disorders.
CONCLUSION
Overall, the occurrence of complications is predictable in most cases. Prevention depends essentially on the constant vigilance of the anesthetist.
INCIDENTS-ACCIDENTS IN GENERAL ANESTHESIA
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