SAFE

ANAESTHESIA
PRACTICE

[Link] Johnson
What do you mean by
that ?
Safety of the Anaesthetist ?

Safety of the Surgeon ?

Safety of the Patient ?

SAFE ANAESTHESIA PRACTICE

Protocals

Crisis Management

Tips and Tricks for

Anaesthesia
PROTOCALS
International Standards
for a
Safe Practice of
Anaesthesia
2010
Developed by the International
Task Force on Anaesthesia
Safety

Adopted by the World

Federation of Societies of
Anaesthesiologists (WFSA)
 International Standards for a Safe
Practice of
Anaesthesia 2010

The goal always in any setting is to practice to the highest

possible standards
"HIGHLY RECOMMENDED"

Minimum standards that would

be expected in all anaesthesia
care for elective surgical
procedures

“Mandatory" standards
Peri-anaesthetic care and
monitoring standards

Pre-anaesthetic care
Pre-anaesthesia checks
Monitoring during
anaesthesia
 Pre-anaesthesia checks
PRE ANAESTHETIC CHECK LIST
Patient name ________________ Number ___________ Date of Birth ­__/__/__
Procedure____________________________________ Site_______

Check
patient risk Check resources Present and
factors Functioning
(if yes - circle and
annotate)

ASA 1 2 3 4 5 E Airway -
Airway N Masks -
Mallampati N Airways -
(pictures) N Laryngoscopes -
Aspiration risk? N (working) -
Allergies? N Tubes -
Abnormal Bougies -
investigations? Breathing -
Medications? Leaks (a FGF of 300 -
Co-morbidities? ml/minute maintains a
Check
patient risk Check resources Present and
factors Functioning
(if yes - circle and
annotate)

ASA 1 2 3 4 5 E Soda lime (colour - if -

Airway present) -
Mallampati Circle system (2-bag test if -
(pictures) present) -
Aspiration risk? Suction -
Allergies? Drugs and Devices -
Abnormal Oxygen cylinder (full and -
investigations? off) -
Medications? Vaporisers (full and -
Co-morbidities? seated) -
Drips (IV secure) -
Drugs (lebeled - TIVA -
connected) -
Blood / fluids available -
Monitors - alarms on -
Humidifiers, warmers and -
thermometers
Monitoring during
anaesthesia
Oxygenation
Airway and ventilation
Circulation
Temperature
Neuromuscular function
Depth of anaesthesia
Audible signals and alarms
 HIGHLY RECOMMENDED SUGGESTED
RECOMMENDED
Oxygenation - Inspired oxygen
- Supplemental oxygen
Oxygen -Un interrupted supply concentration -
supply : - Oxygen supply failure
alarm
- Visual examination,
-Hypoxic Guard
Oxygenation - Adequate -
of the patient : illumination
- Pulse oximetry

--

Airway and - Observation - Precordial, - Continuous

ventilation - Auscultation - Pretracheal, or measurement of
- The reservoir bag -Oesophageal the inspiratory
stethoscope and/or expired
- Capnography gas volumes, and
of the
concentration of
volatile agents
Circulation
Cardiac rate -Palpation of the - Electrocardiograph
and rhythm : pulse - - Defibrillator
Auscultation of the
heart sounds
- Pulse oximetry
Tissue - Capnography
 HIGHLY
RECOMMENDED RECOMMENDED SUGGESTED

- Continual
Temperature - At frequent electronic
intervals temperature
measurement

Neuromuscular - Peripheral nerve

function stimulator

Depth of - Degree of - Continuous

anaesthesia unconsciousness measurement of the - BIS Monitor
(clinical inspiratory and/or
observation) expired gas
volumes, and of the
concentration of
volatile agents
Available audible signals (pulse tone of the pulse
Audible signals oximeter) and audible alarms (with appropriately set
and alarms limit values) should be activated at all times and loud
enough to be heard throughout the operating room
 Crisis Management during
anaesthesia
 Crisis Management
 Crisis Management Manual
developed by Australian Patient
Safety Foundation
Qual Saf Health Care 2005;14

Working groups from several

countries including the USA, UK and
Australia after analysing incident
reports from the 4000 Australian
Incident Monitoring Study (AIMS)
reports and designed Core Algorithm
 Crisis Management Manual
‘‘Core’’ algorithm - COVER ABCD – A SWIFT CHECK
Crisis management algorithm ‘‘COVER
ABCD’’
 Crisis management algorithm ‘‘COVER
ABCD’’
Sub Algorithm – Crisis
Management
 Crisis management
manual Ref.
Crisis management during anaesthesia:
the development of an Anaesthetic
Crisis Management Manual
[Link]
l

Anaesthesia Crisis Management Manual

[Link]
anagement_Start.htm

Thisarticle cites 42 articles, 30 of

which can be accessed free at:
[Link]
 Where Safety Starts ?

Patient
Surgeon’s Skill

Facilities, Equipment, and Medications Anaesthetist’s Skill

Survival Depends.......

Referal
10
%
HELP 10%

20%
Anaesthetist Skill

60%

Facilities, Equipment, and Medications

Quantity and Quality
 Where Safety Starts ?
Patient
- Optimized patient (CVS, RS,
Renal, Liver)
ASA risk
Well controlled Hypertension
Well controlled Diabetes
Haemodynamically stabilsed
 Medication
All drugs should be clearly labelled

The label on both ampoule and

syringe should be read carefully
before the drug is drawn up or
injected

 Ideally drugs should be drawn up

and labelled by the anaesthetist who
administers them.
 Anaesthetist Skill
Learn one or two alternate method of
Airway skill
Practice it in routine cases
Post Crisis
 Counseling

Pre operative counseling

- Possible complicat
- Remote
complication
• Post operative counseling

- The Swiss Foundation for Patient

Safety has published guidelines describing
the actions to take after an adverse event
has occurred .
Recommendations for senior staff
members
A severe medical error is an emergency

 Confidence between the senior staff and the

involved professional

 Involved
professionals need a professional
and objective discussion with, as well as
emotional support from, peers in their
department

 Seniors should offer support for the

disclosing conversation with the patient
and/or the relatives

A professional work-up of that case based on

facts is important for analysis and learning
out of medical error. Ex..
 Recommendations for
colleagues
Be aware that such an adverse
event could happen to you also

Offer time to discuss the case with

your colleague. Listen to what your
colleague wants to tell and support
him/her with your professional
expertise

Address any culture of blame either

directly from within the team or by
any other colleagues
 Recommendations for healthcare
professionals directly involved in an
adverse event
 Do not suppress any feelings of emotion you may
encounter after your involvement in a medical
error

 Talk through what has happened with a

dependable colleague or senior member of staff.
This is not weakness. This represents appropriate
professional behaviour

 Takepart in a formal debriefing session. Try to

draw conclusions and learn from this event. Ex..

 Ifpossible talk to your patient/their relatives and

engage with them in open disclosure
conversations

 If
you experience any uncertainties regarding the
management of future cases seek support from
Tips and Tricks for
Anaesthesia
 Facilities and Equipments
(LMA )
Macintosh Airways

Magill

Igel

Miller

(GEB)

Polio

Endotracheal Tube Introducer

Mc Coy
Infra - glottic Invasive
Airways
Cricothyrotomy Tracheostomy
Unanticipated Difficult
Airway
Techniques to decrease hypotension
with neuraxial anesthesia for
cesarean delivery.
 Leg wrapping
 Prehydration or co-load with intravenous
colloid solution
 Co-load with crystalloid intravenous solution
 Lower dose intrathecal local anesthesia
supplemented with opioid
 Maternal left uterine displacement positioning
 Consider epidural instead of spinal anesthesia
 Phenylephrine infusion with rapid crystalloid
co-load
 Phenylephrine infusion with low-dose
intrathecal bupivacaine
 Phenylephrine infusion or boluses titrated to
maintain a consistent heart rate
Expert Review of Obstetrics & Gynecology
Katherine W Arendt; Jochen D Muehlschlegel; Lawrence C Tsen
OBESE -
AIRWAY
AIRWAY
CORRECTION Build a BIG RAMPPPP
Perianesthetic Management of
Laryngospasm
The Laryngospasm Notch
Technique
The Laryngospasm Notch
Technique
Unorthodox method: not
generally accepted, better
than nothing
Emergency Airway
SAFE ANAESTHESIA PRACTICE
Thank you