The occurrence of anesthesia accidents may affect the performance of anesthesia surgery, bring pain to the patient and delay recovery, or bring disability or even death to the patient. From the viewpoint of some clinical “anesthesia accidents”, the so-called anesthesia accidents are actually the result of anesthesiologists’ negligence and carelessness. Therefore, it can be said that most anesthesia accidents can be avoided as long as the anesthesia process is well thought out, experience is constantly summarized, and every detail of the anesthesia process is paid attention to.
In the spirit of “failure is the mother of success” and “learn a lesson, grow a wisdom”, we have written some cautionary words (articles) to avoid anesthesia accidents in the past few years, which may be beneficial to the first-time anesthesiologists.
1. The three principles of anesthesia: ensure safety, reduce pain, and create conditions for surgery.
2, anesthesia three must and three not allowed “anesthesia must understand the condition and treatment process before anesthesia, do not understand the patient’s condition is not allowed to do anesthesia; anesthesia must check the patient (blood pressure, pulse, breathing, heart, lungs) before anesthesia, do not check the patient is not allowed to do anesthesia; anesthesia must do a good anesthesia plan and the necessary anesthesia equipment, drug preparation, not ready to do anesthesia.
3, surgery is divided into small and large, anesthesia has a long and short, known as “small surgery”, unique non-small anesthesia.
4. When evaluating a patient, the following questions must be answered: Is the patient suitable for anesthesia? What kind of anesthesia is suitable for? What special treatment is needed before anesthesia? What kind of preanesthetic medication should be used? What can happen during induction of anesthesia? How to prevent? How to deal with it? What can happen during the maintenance period? How to deal with it? What are the possible complications after anesthesia? How should they be avoided? How to deal with it, etc.
5. It is difficult to maintain smoothness when induction is not smooth.
6. Do not forget that the anesthesiologist is the guardian of patient safety.
7. Anesthesia one thousand and one, also like just do the first.
8. “Not afraid of 10,000, but afraid of what if”
9. If the drip is smooth, the flag will be opened.
10. Get into the habit of repeatedly checking (intubation, laryngoscope, drugs, oxygen, etc.) supplies before starting anesthesia.
11. No first aid equipment, no anesthesia, “high art” in case of blindness.
12. Immature technology is the root cause of accidents.
13, “routine” is the crystallization of practical experience, can not be ignored.
14, the most familiar anesthesia (drugs, methods) is the anesthesia of choice when dealing with difficult patients.
15. To personally determine how the patient’s heart and lung function. Do not passively follow the opinion of internal medicine or pediatrician, and do not forget that you are the one doing the anesthesia and not others.
16. If you are mentally exhausted, drunk or impatient, you are prone to make mistakes and accidents when doing anesthesia.
17. It is not too early to find cyanosis, emergency resuscitation can save life, obstruction decannulation insertion deep, bad blood pressure is the reason.
18. Fast pulse, dark blood color and arrhythmia are often the early manifestation of hypoxia, the operator said the blood color is dark, the anesthesiologist first find the cause.
19, must be responsible for the level, according to the instructions of the higher doctor to do, there are comments later to mention, “single interest” should not be.
20, anesthesia in the spirit of concentration, not away from the patient, no gossip, no newspaper, no sleep, the spirit of concentrated care of anesthesia, patient safety is guaranteed, a long operation, anesthesia fatigue, burnout, dozing is not uncommon, gossip, mental distraction is also common, these can give the patient to harm.
21, change of position immediately check blood pressure, pulse, breathing. Changing position often causes changes in respiration and circulation. If symptoms of respiratory obstruction appear, consider whether the tracheal tube is dislodged, too deep, curved, or compressed by the capsule.
22. Use the respiratory bag first and then the ventilator. Do not use the ventilator immediately after anesthesia, but use the respiratory capsule first to relax the muscles and then switch to the ventilator after the blood pressure, pulse rate and breathing are normal.
23. Hold the laryngoscope in the left hand and lift it up firmly, avoiding the tongue and not to crush the lower lip. Reasons for failure of intubation.
(1) Insufficient force in the left hand. (2) The tip of the lens is not correct. (3) The tongue is not pushed to the left.
24. Rapid transfusion of blood and fluids should be supervised.
25. Do not forget that hypoxia and carbon dioxide accumulation are the source of danger.
26. The anesthesiologist should have a sharp hearing ear and should be able to hear the patient’s breathing in any situation like a mother can hear the baby’s cry in deep sleep and judge the patient’s condition from the breathing sound.
27. Watch the patient’s breathing and blood pressure, patient safety is guaranteed.
28. Holding the ball in one hand (breathing bag) and feeling the pulse with the other hand, watching the patient’s operating table, is the key to early detection of problems.
29. Check the anesthesia first when there is a sudden illness, and do the treatment while reducing the shallow anesthesia.
30, anesthesiologists in case of accidents to do while looking for people, while handling, calm and composed, bold and careful, timely handling.
31, the patient does not go not to close the stall. Surgery is over, the mind is often relaxed, eager to close the stall (take away the laryngoscope, suction device, etc.), often make the handling of accidents by surprise.
32. Red and warm will not die, wet and cold pale danger, intraoperative sweating, commonly due to high body temperature, shallow anesthesia, hypoglycemia, carbon dioxide accumulation, cold sweating is an early manifestation of shock. 6. Good quality control, this is an important criterion.
33. Prone position or sitting position is dangerous for surgery: this position is easy to cause changes in the circulatory system, also easy to occur intubation slippage and too deep or complications such as respiratory depression, impaired ventilation, air embolism, and even cardiac arrest, once the problem occurs, resuscitation is not convenient.
34, arrhythmia in anesthesia, to do hyperventilation first, Mo and medication, the emergence of arrhythmia should be done while hyperventilation, clear hypoxia and carbon dioxide accumulation, adjust the depth of anesthesia, while looking for the nature of arrhythmia, do not immediately use lidocaine, procaine amide, insulin and other antiarrhythmic drugs.
35. Think ahead in order to take the initiative, the operation is often carried out beyond the preoperative estimates, anesthesia management should be constantly measured step by step, so as to take the appropriate disposal.
36. Check the airway when wheezing occurs: first check whether the tracheal tube is inserted too deeply, whether the air sac is inflated too much, and whether there is any accumulation of respiratory secretions, and if it is really a wheezing attack, ketamine can be effective when injected by sedation.
37, even a little worried about things, but also to immediately solve: anesthesia often make people slightly worried about things, such as: “the patient’s blood color is too good”, “a small amount of secretions in the respiratory tract to retain”, “blood transfusion is not quite enough “, “There may not be enough oxygen”, “The IV is not flowing well”, “Is one IV enough”? “It’s probably safe to do a tracheotomy first”! The thought of almost not caring can sometimes lead to serious consequences. The concern is addressed immediately, do not take care of the operator or accommodate.
38. Epidural anesthesia is safe only if you watch your breathing.
39, drug injection epidural, symptoms appear quickly, not only the whole spinal anesthesia, into the blood is not excluded.
40, anesthesia according to the steps, the operation should be light and steady, injury can be avoided. Such as tracheal intubation, epidural anesthesia, lumbar anesthesia, nerve block and other operations, to step by step, light and steady operation, can avoid paying injury.
41. After tracheal intubation to listen to the lung breathing sounds, so as not to enter too deep into the side.
42. Knowing that the intubation out of the terrible, as first think of a safe way. Toothless, breastfeeding, oral surgery, head surgery, special positions (sitting, prone, etc.), intraoperative tracheal tube prolapse is most likely to occur, and should be fixed in advance.
43. Do not forget to observe for 10 minutes. After the injection of local anesthetic, position, disinfection, cover dressing, surgery is very dangerous, must be observed for 10 minutes, blood pressure, pulse, breathing stable before starting to be safe.
44. Short neck, fat body, small jaw, long incisors, and no teeth make intubation difficult.
45. Familiar operation should not be careless.
46. Rough operation often means the beginning of an accident.
47. Don’t do it reluctantly, ask for another high level: when doing intravenous puncture, endotracheal intubation, lumbar anesthesia, epidural anesthesia puncture, arterial puncture, block anesthesia operation, do some efforts, but still can’t succeed, stubbornly insist on not letting go, most of them can’t get good results, we should ask for another high level in due course.
48, practice a good skill, the patient’s life is guaranteed. In very urgent cases, the success of venipuncture, tracheal intubation is often directly related to the life of the patient, a hand-held mask, a hand-held breathing bag to do to help breathing is also a test of the basic skills of anesthesia how to mark, plain diligence plus formal operation is a shortcut to develop excellent skills, emergency but not panic, accurate operation.
49. If you are not sure about intubation, do not do rapid induction.
50, do not forget to use thiopental sodium, central nervous system depressants, breathing can be stopped at any time.
51, myorelaxants are respiratory arrest drugs. As long as the use of muscle relaxants should be thought of breathing inevitably inhibited or stopped, to be prepared for intubation, anesthesia machine, oxygen, and then muscle relaxants.
52, high blood potassium is not used to scotin. In patients with burns, uremic syndrome, crush syndrome, tetraplegia, etc. whose blood potassium may be high, the use of corticosteroids may cause cardiac rhythm disturbance and cardiac arrest due to a sharp rise in blood potassium.
53. Repeated use of inotropic drugs can delay voluntary breathing.
54. Impatience is often the culprit. If neostigmine does not antagonize inotropic drugs, continue to do rescue breathing, impatience, use of excessive amounts of neostigmine is dangerous. In dehydration, acidosis, hypokalemia, and impaired peripheral circulation, antagonizing muscarinic drugs with neostigmine often does not work, so consider the reasons and continue to do rescue breathing, not to use drugs in a hurry. Another example: the epidural anesthesia test dose observation time is less than the full amount of injection, very dangerous.
55, local anesthetic poisoning convulsions, do not forget to use thiopental sodium and oxygen.
56, although the elderly are robust, but ultimately the elderly, the use of drugs should be careful, a small number of times the safest. In the elderly use of thiopental sodium, analgesic sedatives, nerve blocking drugs, muscle relaxants, local anesthetics, halothane, etc., according to the normal human dosage of drugs, often can bring about a drop in blood pressure, respiratory depression and other serious consequences.
57. The induction of aneurysm should be smooth, and be alert to the surge of blood pressure and choking cough.
58. Head and face surgery is problematic, keep an eye on breathing with certainty. Patients who eat are prone to vomiting, and fasting decreases secretion without excusing. Cleft lip, consternation, tonsil removal, vocal cord polyps, tracheal foreign body removal, anesthesia is often far from the head, can not directly manage the respiratory tract, late detection of problems. Emergency patients are often full and have more chances to vomit, so a well-managed airway is often a guarantee of safety, and if conditions allow, anesthesia should be performed after emptying the stomach contents.
59. Pediatric and pregnant women have many physiological characteristics, and the operation and medication situation are individual.
60. Do not do unfamiliar anesthesia and do not use unfamiliar drugs at night or in emergency.
61. It is dangerous not to prepare for xanthogranuloma, intestinal obstruction, peritonitis, and shock in the early stage. In this type of acute abdomen, there are often changes such as fever, acidosis, electrolyte disorders, abnormal ECG, and renal insufficiency, and it is dangerous to perform anesthesia without preparation (correction).
62. Patients in shock are most likely to suffer cardiac arrest: patients in shock can suffer respiratory and circulatory failure and cardiac arrest due to sudden change of position, rapid blood transfusion, fluid infusion, hypoxia, and administration of anesthetics.
63. The patient does not leave the person before waking up, anesthesia awakening problems.
64.Patients do not wake up after anesthesia to find the reason. If the patient does not wake up for a certain period of time after general anesthesia, we should find the reasons, such as blood gas, temperature, urine, electrolytes and other tests, and also consider the effect of the operation itself and muscle relaxation drugs.