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Demilie AE, Denu ZA, Bizuneh YB, Gebremedhn EG. Incidence and factors associated with failed spinal anaesthesia among patients undergoing surgery: a multi- center prospective observational study. BMC Anesthesiol 2024; 24:129. [PMID: 38580926 PMCID: PMC10996260 DOI: 10.1186/s12871-024-02484-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Accepted: 03/06/2024] [Indexed: 04/07/2024] Open
Abstract
BACKGROUND Failed spinal anaesthesia causes prolonging of operation time, insufficient analgesia for surgery and needs repeating spinal anaesthesia which in turn causes local anaesthesia toxicity, high spinal and total spinal, and conversion to general anaesthesia. However, the problem remains unexplored in Amhara regional state comprehensive specialized hospitals. OBJECTIVE To determine incidence and factors associated with failed spinal anaesthesia among patients undergoing surgery in selected Amhara National Regional State comprehensive specialized hospitals, Northwest Ethiopia, 2023. METHODS Multi-center prospective observational study was conducted. Data was collected using questionnaire and checklist. All consecutive scheduled emergency and elective patients were included in the study. Data was transformed from Epi data to SPSS and logistic regression analysis was done. Both crude and adjusted odds ratio were used to assess the strength of association. Variables with a p-value of less than 0.05 were considered as statistically significant. RESULTS A total of 532 patients were included in this study with a response rate of 98%. Incidence of failed spinal anaesthesia was 22.4% (CI = 19-25.9). Emergency surgery (AOR = 7.01, CI = 4.5-12.7), dose of bupivacaine of ≤ 10 mg (AOR = 3.02, CI = 1.3-10.2), work experience of anaesthetist < 2 years (AOR = 3.1, CI = 1.7-5.72), bloody CSF (AOR = 8.5, CI = 2.53-18.5), hyperbaric local anaesthetic drug (AOR = 3.3, 95% CI = 3.2-8.2) and local anaesthetist without adjuvants (AOR = 5.25, CI = 2.62-14.2) were associated failed spinal anaesthesia. CONCLUSION AND RECOMMENDATION The incidence of failed spinal anaesthesia was high in Amhara Region comprehensive specialized hospitals. We suggest that anaesthesia providers should minimize failure by using adjuvants and appropriate dose of local anaesthetic. Additionally, simulation training should be given for anaesthesia trainees to improve their skills and to produce competent professionals.
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Affiliation(s)
- Atalay Eshetie Demilie
- Department of Anaesthesia, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Zewditu Abdissa Denu
- Department of Anaesthesia, School of Medicine, Gondar College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Yosef Belay Bizuneh
- Department of Anaesthesia, School of Medicine, Gondar College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Endale Gebreegziabher Gebremedhn
- Department of Anaesthesia, School of Medicine, Gondar College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
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Kielty J, Carton M, Hayes N, Ni Eochagain A. Spinal anaesthesia for caesarean section in a patient with eclampsia and posterior reversible encephalopathy syndrome. Int J Obstet Anesth 2024; 57:103971. [PMID: 38212208 DOI: 10.1016/j.ijoa.2023.103971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 11/03/2023] [Accepted: 12/11/2023] [Indexed: 01/13/2024]
Affiliation(s)
- J Kielty
- Mater Misericordiae University Hospital, Dublin, Ireland; The Rotunda Hospital, Dublin, Ireland.
| | - M Carton
- Mater Misericordiae University Hospital, Dublin, Ireland; The Rotunda Hospital, Dublin, Ireland
| | - N Hayes
- Mater Misericordiae University Hospital, Dublin, Ireland; The Rotunda Hospital, Dublin, Ireland
| | - A Ni Eochagain
- Mater Misericordiae University Hospital, Dublin, Ireland; The Rotunda Hospital, Dublin, Ireland
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Chiew JK, Low CJW, Zeng K, Goh ZJ, Ling RR, Chen Y, Ti LK, Ramanathan K. Thoracic Epidural Anesthesia in Cardiac Surgery: A Systematic Review, Meta-Analysis, and Trial Sequential Analysis of Randomized Controlled Trials. Anesth Analg 2023; 137:587-600. [PMID: 37220070 DOI: 10.1213/ane.0000000000006532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
BACKGROUND Research on fast-track recovery protocols postulates that thoracic epidural anesthesia (TEA) in cardiac surgery contributes to improved postoperative outcomes. However, concerns about TEA's safety hinder its widespread usage. We conducted a systematic review and meta-analysis to assess the benefits and risks of TEA in cardiac surgery. METHODS We searched 4 databases for randomized controlled trials (RCTs) assessing the use of TEA against only general anesthesia (GA) in adults undergoing cardiac surgery, up till June 4, 2022. We conducted random-effects meta-analyses, evaluated risk of bias using the Cochrane Risk-of-Bias 2 tool, and rated certainty of evidence via the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) approach. Primary outcomes were intensive care unit (ICU), hospital length of stay, extubation time (ET), and mortality. Other outcomes included postoperative complications. Trial sequential analysis (TSA) was conducted on all outcomes to elicit statistical and clinical benefit. RESULTS Our meta-analysis included 51 RCTs (2112 TEA patients and 2220 GA patients). TEA significantly reduced ICU length of stay (-6.9 hours; 95% confidence interval [CI], -12.5 to -1.2; P = .018), hospital length of stay (-0.8 days; 95% CI, -1.1 to -0.4; P < .0001), and ET (-2.9 hours; 95% CI, -3.7 to -2.0; P < .0001). However, we found no significant change in mortality. TSA found that the cumulative Z-curve passed the TSA-adjusted boundary for ICU length of stay, hospital length of stay, and ET, suggesting a clinical benefit. TEA also significantly reduced pain scores, pooled pulmonary complications, transfusion requirements, delirium, and arrhythmia, without additional complications such as epidural hematomas, of which the risk was estimated to be <0.14%. CONCLUSIONS TEA reduces ICU and hospital length of stay, and postoperative complications in patients undergoing cardiac surgery with minimal reported complications such as epidural hematomas. These findings favor the use of TEA in cardiac surgery and warrant consideration for use in cardiac surgeries worldwide.
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Affiliation(s)
- John Keong Chiew
- From the Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore
| | - Christopher Jer Wei Low
- From the Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore
| | - Kieran Zeng
- Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Zhi Jie Goh
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Ryan Ruiyang Ling
- From the Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore
| | - Ying Chen
- From the Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore
- Agency of Science, Technology and Research, Singapore
| | - Lian Kah Ti
- From the Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore
- Department of Anaesthesia, National University Hospital, National University Health System, Singapore
| | - Kollengode Ramanathan
- From the Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore
- Department of Cardiac, Thoracic and Vascular Surgery, Cardiothoracic Intensive Care Unit, National University Heart Centre, National University Hospital, National University Health System, Singapore
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4
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Stanford SER. What is 'genuine' failure of neuraxial anaesthesia? Anaesthesia 2022; 77:523-526. [PMID: 35332526 DOI: 10.1111/anae.15723] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 03/08/2022] [Accepted: 03/15/2022] [Indexed: 01/26/2023]
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Plaat F, Stanford SER, Lucas DN, Andrade J, Careless J, Russell R, Bishop D, Lo Q, Bogod D. Prevention and management of intra-operative pain during caesarean section under neuraxial anaesthesia: a technical and interpersonal approach. Anaesthesia 2022; 77:588-597. [PMID: 35325933 PMCID: PMC9311138 DOI: 10.1111/anae.15717] [Citation(s) in RCA: 36] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 02/28/2022] [Accepted: 03/01/2022] [Indexed: 11/27/2022]
Abstract
A woman who experiences pain during caesarean section under neuraxial anaesthesia is at risk of adverse psychological sequelae. Litigation arising from pain during caesarean section under neuraxial anaesthesia has replaced accidental awareness under general anaesthesia as the most common successful medicolegal claim against obstetric anaesthetists. Generic guidelines on caesarean section exist, but they do not provide specific recommendations for this area of anaesthetic practice. This guidance aims to offer pragmatic advice to support anaesthetists in caring for women during caesarean section. It emphasises the importance of non-technical skills, offers advice on best practice and aims to encourage standardisation. The guidance results from a collaborative effort by anaesthetists, psychologists and patients and has been developed to support clinicians and promote standardisation of practice in this area.
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Affiliation(s)
- F Plaat
- Department of Anaesthesia, Queen Charlottes and Chelsea Hospital, London, UK
| | | | - D N Lucas
- Department of Anaesthesia, London North West University Healthcare NHS Trust, London, UK
| | - J Andrade
- School of Psychology, University of Plymouth, Plymouth, UK
| | - J Careless
- Associate Specialist, Department of Anaesthesia, Buckinghamshire Healthcare NHS Trust, Buckinghamshire, UK
| | - R Russell
- Department of Anaesthesia, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - D Bishop
- Metropolitan Department of Anaesthetics, Critical Care and Pain Management, University of KwaZulu-Natal, Pietermaritzburg, South Africa
| | - Q Lo
- Department of Anaesthesia, The Royal Marsden NHS Foundation Trust, London, UK
| | - D Bogod
- Department of Anaesthesia, Nottingham University Hospitals NHS Trust, Nottingham, UK
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6
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Oglesby FC, Ray AG, Shurlock T, Mitra T, Cook TM. Litigation related to anaesthesia: analysis of claims against the NHS in England 2008-2018 and comparison against previous claim patterns. Anaesthesia 2022; 77:527-537. [PMID: 35247933 DOI: 10.1111/anae.15685] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 01/13/2022] [Accepted: 01/21/2022] [Indexed: 12/14/2022]
Abstract
We reviewed all 1230 claims against anaesthesia notified to NHS Resolution (formerly the NHS Litigation Authority, 1995-2017) in England between 2008 and 2018. Claims were categorised by incident type, severity (whether physical or psychological), and cost, and comparisons were made against a similar published analysis of data from 1995 to 2007. While the annual number of claims against anaesthesia increased by 62% from the earlier period, anaesthesia now accounts for smaller proportions of all claims submitted to NHS Resolution (1.5% vs. 2.5%) and of the total cost of all claims (0.7% vs. 2.4%). The absolute costs related to anaesthesia claims rose over 300%, totalling £145 million between 2008 and 2018, but the mean cost per closed claim (retail price index adjusted) fell by 6% to £74,883. The most common clinical categories were regional anaesthesia (24%), inadequate anaesthesia (20%) and drug administration (20%). Claims related to airway management, central venous catheterisation and cardiac arrest remained infrequent but severe and costly. The proportion of claims relating to regional anaesthesia and obstetric anaesthesia fell significantly, but claims relating to peripheral nerve blockade doubled. Our analysis includes categories relating to organisational and human factors which are present in a substantial proportion of claims; categories with the highest mean cost per claim included delayed care, planning, monitoring and consent. Overall, the specialty of anaesthesia is at low risk of litigation. Our analysis provides important insights into current and changing patterns in claim distributions that may help improve the quality of patient care and reduce future litigation. We recommend the establishment of a structure for national review and learning from all cases of litigation.
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Affiliation(s)
- F C Oglesby
- Department of Anaesthesia and Intensive Care Medicine, Royal United Hospitals, Bath
| | - A G Ray
- Department of Anaesthesia and Intensive Care Medicine, North Bristol NHS Trust, Bristol
| | | | | | - T M Cook
- Department of Anaesthesia and Intensive Care Medicine, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK.,University of Bristol, Bristol, UK
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Identification and economic burden of main adverse events of nerve injuries caused by regional anesthesia: a systematic review. Braz J Anesthesiol 2021; 73:305-315. [PMID: 33823209 DOI: 10.1016/j.bjane.2021.02.043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 01/03/2021] [Accepted: 02/06/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Anesthesiologists and hospitals are increasingly confronted with costs associated with the complications of Peripheral Nerve Blocks (PNB) procedures. The objective of our study was to identify the incidence of the main adverse events associated with regional anesthesia, particularly during anesthetic PNB, and to evaluate the associated healthcare and social costs. METHODS According to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we conducted a systematic search on EMBASE and PubMed with the following search strategy: ("regional anesthesia" OR "nerve block") AND ("complications" OR "nerve lesion" OR "nerve damage" OR "nerve injury"). Studies on patients undergoing a regional anesthesia procedure other than spinal or epidural were included. Targeted data of the selected studies were extracted and further analyzed. RESULTS Literature search revealed 487 articles, 21 of which met the criteria to be included in our analysis. Ten of them were included in the qualitative and 11 articles in the quantitative synthesis. The analysis of costs included data from four studies and 2,034 claims over 51,242 cases. The median claim consisted in 39,524 dollars in the United States and 22,750 pounds in the United Kingdom. The analysis of incidence included data from seven studies involving 424,169 patients with an overall estimated incidence of 137/10,000. CONCLUSIONS Despite limitations, we proposed a simple model of cost calculation. We found that, despite the relatively low incidence of adverse events following PNB, their associated costs were relevant and should be carefully considered by healthcare managers and decision makers.
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Ashagrie HE, Ahmed SA, Melesse DY. The incidence and factors associated with failed spinal anesthesia among parturients underwent cesarean section, 2019: A prospective observational study. INTERNATIONAL JOURNAL OF SURGERY OPEN 2020. [DOI: 10.1016/j.ijso.2020.03.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Bai JW, Abdallah FWW, Cohn M, Ladowski S, Madhusudan P, Brull R. Say what? Patients have poor immediate memory of major risks of interscalene block disclosed during the informed consent discussion. Reg Anesth Pain Med 2019; 44:rapm-2019-100858. [PMID: 31446397 DOI: 10.1136/rapm-2019-100858] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 08/08/2019] [Accepted: 08/14/2019] [Indexed: 11/03/2022]
Abstract
BACKGROUND Poor memory of disclosed risks can undermine informed consent and create medicolegal challenges. The extent to which patients remember the risks of peripheral nerve blockade following the informed consent discussion is unknown. This prospective cohort study evaluated patients' immediate memory of risks related to interscalene block (ISB) that were disclosed during the preoperative informed consent discussion. METHODS Using a standardized script, patients scheduled for arthroscopic shoulder surgery were informed of the risks of ISB by an anesthesiologist in the preoperative assessment clinic. Immediately thereafter, consenting participants were asked to identify the risks of ISB from a printed list of nine true risks (four major and five minor) and nine 'distractor' items, which were unrelated adverse events and not disclosed. The primary outcome was the proportion of participants who remembered all four true major risks including long-term nerve damage, seizure, life-threatening event, and damage to the covering of the lung. RESULTS Among 125 participants, only 26 (21%) remembered all four major risks of ISB. The mean number of major risks remembered was 2±1 out of 4. Fifteen (12%) participants remembered all nine true risks. The mean number of true risks remembered was 6±2 out of 9. Multivariable analysis revealed that participants' self-rated assessment of their memory was not associated with actual recall. CONCLUSION Patients have poor immediate memory of the major risks related to ISB disclosed during the informed consent discussion. Under the present study conditions, the validity of the informed consent process for patients undergoing ISB may be undermined.
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Affiliation(s)
- Johnny Wei Bai
- Department of Anesthesia, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Faraj W W Abdallah
- Deparment of Anesthesia, University of Ottawa Faculty of Medicine, Ottawa, Ontario, Canada
- Department of Anesthesia and the Li Ka Shing Knowledge Institute, University of Toronto, Toronto, Ontario, Canada
| | - Melanie Cohn
- Department of Psychology, University of Toronto, Toronto, Ontario, Canada
| | - Stephanie Ladowski
- Department of Anesthesia, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Poorna Madhusudan
- Department of Anesthesia, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Richard Brull
- Department of Anesthesia, Toronto Western Hospital, Toronto, Ontario, Canada
- Department of Anesthesia, Women's College Hospital, Toronto, Ontario, Canada
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10
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de Santana Lemos C, de Brito Poveda V. Adverse Events in Anesthesia: An Integrative Review. J Perianesth Nurs 2019; 34:978-998. [PMID: 31005390 DOI: 10.1016/j.jopan.2019.02.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2018] [Revised: 02/16/2019] [Accepted: 02/23/2019] [Indexed: 12/23/2022]
Abstract
PURPOSE This study conducted an integrative review of the literature in a search for scientific evidence related to the occurrence of perioperative adverse events resulting from anesthesia. DESIGN Integrative review. METHODS The search was performed in the PubMed/MEDLINE, Virtual Health Library, Cumulative Index to Nursing and Allied Health, and Web of Science databases and portals, including studies published in Portuguese, English, or Spanish, from 1997 to 2017. The studies were supposed to assess adverse events associated exclusively with anesthesia care. FINDINGS We selected 21 studies. The main adverse events in anesthesia were respiratory, drug error, cardiology, and neurology. Most of the events were related to human errors, slips, and lapses that resulted in damage to the patient, such as permanent injuries or death. CONCLUSIONS Care planning, efficient communication, and teamwork are critical to prevent adverse events in anesthesia.
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12
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Goy RWL, Ithnin F, Lew E, Sng BL. Exploring the challenges of task-centred training in obstetric anaesthesia in the operating theatre environment. Int J Obstet Anesth 2019; 39:88-94. [PMID: 30852134 DOI: 10.1016/j.ijoa.2019.02.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 01/26/2019] [Accepted: 02/07/2019] [Indexed: 11/24/2022]
Abstract
BACKGROUND Task-centred learning forms the basis of procedural training in obstetric anaesthesia. We observed that our residents were not building their competence from experiential practice in the operating theatre. We used a broad-based framework to explore the challenges encountered by the residents and clinical supervisors in the learning and teaching of obstetric anaesthesia. METHODS The study was conducted at the KK Women's and Children's Hospital, Singapore, from 1 December 2016 to 30 June 2017. A semi-structured interview format was used in the focus group and individual interviews. Information collection continued until data saturation was reached. The interviews were analysed and the challenges were identified. Fourteen residents and five clinical supervisors participated in the focus group and individual interviews respectively. FINDINGS The operating theatre constituted a stressful learning and teaching environment for the participants. Five categories of challenges were identified: (1) clinical conditions, (2) concerns about maternal risk and outcomes, (3) reluctance of the residents to vocalise their learning needs, (4) poor feedback, and (5) lack of opportunities for inter-professional practice. These collective challenges reduced the quality of task-centred learning and the effectiveness of supervisor teaching. We described some strategies to overcome these challenges (dedicated trainee lists, obstetric anaesthesia reflective diary, active mentoring system and in-situ simulation). CONCLUSIONS Our study described the challenges of obstetric anaesthesia training in the operating theatre environment in an Asian healthcare setting. Research is needed on the influence of supervisors' concern about maternal risks and their teaching behaviours.
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Affiliation(s)
- R W L Goy
- Women's Anaesthesia, KK Women's and Children's Hospital, Singapore.
| | - F Ithnin
- Women's Anaesthesia, KK Women's and Children's Hospital, Singapore
| | - E Lew
- Women's Anaesthesia, KK Women's and Children's Hospital, Singapore
| | - B L Sng
- Women's Anaesthesia, KK Women's and Children's Hospital, Singapore
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McCombe K, Bogod DG. Learning from the Law. A review of 21 years of litigation for pain during caesarean section. Anaesthesia 2017; 73:223-230. [PMID: 29090735 DOI: 10.1111/anae.14119] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/03/2017] [Indexed: 01/04/2023]
Abstract
The large majority of caesarean sections in the UK are now carried out under neuraxial anaesthesia. Although this technique is widely accepted as being the safest option in most circumstances, the use of regional anaesthesia increases the risk of patients experiencing intra-operative discomfort or pain. Pain during operative obstetric delivery is the commonest successful negligence claim relating to regional anaesthesia against obstetric anaesthetists in the UK. In the following article, using a database of over 360 cases spanning 21 years, we break down and examine the recurrent components of medicolegal claims concerning pain during caesarean section and consider how anaesthetists might avoid litigation.
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Affiliation(s)
- K McCombe
- Department of Anaesthesia, Mediclinic City Hospital, Dubai Healthcare City, Dubai, UAE.,Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, UAE
| | - D G Bogod
- Department of Anaesthesia, Nottingham University Hospitals NHS Trust, Nottingham, UK
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15
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Alabi AA, Adeniyi OV, Adeleke OA, Pillay P, Haffajee MR. Factors associated with failed spinal anaesthesia for Caesarean sections in Mthatha general hospital, Eastern Cape, South Africa. S Afr Fam Pract (2004) 2017. [DOI: 10.1080/20786190.2017.1292696] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Affiliation(s)
| | - Oladele Vincent Adeniyi
- Department of Family Medicine, Cecilia Makiwane Hospital, East London Hospital Complex, Walter Sisulu University, Eastern Cape, South Africa
| | | | - Pamela Pillay
- School of Laboratory Medicine & Medical Sciences, Department of Anatomy, University of KwaZulu-Natal, Durban, South Africa
| | - Mohamed Rashid Haffajee
- School of Laboratory Medicine & Medical Sciences, Department of Clinical Anatomy, University of KwaZulu-Natal, Durban, South Africa
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Sondekoppam RV, Tsui BCH. Factors Associated With Risk of Neurologic Complications After Peripheral Nerve Blocks. Anesth Analg 2017; 124:645-660. [DOI: 10.1213/ane.0000000000001804] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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17
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Mankowitz SKW, Gonzalez Fiol A, Smiley R. Failure to Extend Epidural Labor Analgesia for Cesarean Delivery Anesthesia. Anesth Analg 2016; 123:1174-1180. [DOI: 10.1213/ane.0000000000001437] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Gupta AK, Morton JR. Cadaveric training - the solution for ultrasound-guided regional anaesthesia? Anaesthesia 2016; 71:874-8. [DOI: 10.1111/anae.13538] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- A. K. Gupta
- Academic Health Sciences Centre; Cambridge University Health Partners; Cambridge UK
- Department of Anaesthesia and Neuro-intensive Care; Cambridge University Hospitals; Cambridge UK
| | - J. R. Morton
- Department of Colorectal Surgery; Cambridge University Hospitals; Cambridge UK
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19
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Dale MC, Checketts MR. Complications of regional anaesthesia. ANAESTHESIA AND INTENSIVE CARE MEDICINE 2016. [DOI: 10.1016/j.mpaic.2015.12.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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20
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Domino KB, Posner KL. Legal Research Databases to Study Rare Perioperative Outcomes in Patients with Obstructive Sleep Apnea. Anesth Analg 2016; 122:10-2. [DOI: 10.1213/ane.0000000000001078] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Hoyle J, Yentis SM. Assessing the height of block for caesarean section over the past three decades: trends from the literature. Anaesthesia 2014; 70:421-8. [DOI: 10.1111/anae.12927] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/28/2014] [Indexed: 11/30/2022]
Affiliation(s)
- J. Hoyle
- Chelsea and Westminster Hospital; London UK
| | - S. M. Yentis
- Chelsea and Westminster Hospital; London UK
- Imperial College; London UK
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22
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White V, Nath A, Stansby G. Litigation claims relating to venous thromboembolism in the NHS. Phlebology 2014; 30:389-96. [DOI: 10.1177/0268355514537487] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Aim Litigation costs for clinical negligence in the management of venous thromboembolism have escalated in the last five years. The National Health Service Litigation Authority estimates these claims have cost in excess of £112 million. Our aim is to identify the areas of practice where these claims are most likely to arise to help improve patient outcome. Methods The National Health Service Litigation Authority provided de-identified data on individual medical negligence claims against the NHS since 2007. We subcategorised the data into (a) the nature of the venous thromboembolism event, (b) the area of specialist practice and (c) the damages incurred. Inter-group differences were evaluated using ANOVA, Kruskal–Wallis test and Mann–Whitney U Test. Results Failure to prevent and to diagnose pulmonary emboli and deep vein thrombosis occurs across the spectrum of clinical specialties. In the study period 189 claims were made. The majority of claims were in surgical specialties and the financial burden was significantly greater than in the medical specialities (£3,257,394 vs. £1,532,996). The amounts paid out by specialty was not significantly different but had significant variance ( p < 0.0001). Conclusions The National Institute of Clinical Excellence provides comprehensive guidelines on venous thromboembolism risk assessment. Poor compliance has contributed to morbidity and mortality while the cost has continued to escalate. A multimodal approach to education is needed to improve patient outcome. Improved venous thromboembolism prevalence data are also needed.
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Affiliation(s)
- Victoria White
- Northern Vascular Centre, Freeman Hospital, Newcastle-upon-Tyne, UK
| | - Alexander Nath
- Northern Vascular Centre, Freeman Hospital, Newcastle-upon-Tyne, UK
| | - Gerard Stansby
- Northern Vascular Centre, Freeman Hospital, Newcastle-upon-Tyne, UK
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A randomized, observer-blind comparison between the Neurotip mounted Neuropen and a disposable plastic neurological wheel for assessing the level of spinal blockade at cesarean section. Int J Obstet Anesth 2014; 23:125-30. [PMID: 24569062 DOI: 10.1016/j.ijoa.2013.11.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2013] [Revised: 10/14/2013] [Accepted: 11/17/2013] [Indexed: 11/23/2022]
Abstract
BACKGROUND Various methods are used to assess the height of sensory block to touch under spinal anesthesia for cesarean section. We tested a novel, inexpensive, miniature, user-dependent plastic neurological wheel against the user-independent Neurotip mounted Neuropen. METHODS Patients received either spinal or combined spinal-epidural anesthesia. For each patient assessment, the devices were randomly assigned to one of two independent investigators. The order of device application was randomly permuted. Neither researcher was involved with anesthetic care. At 5-min intervals for 20 min after spinal injection, and again at the end of the operation, the levels of block to loss-of-touch sensation were assessed. While one investigator evaluated the block, the other left the operating room and vice versa. Mixed-effects regression and Bland-Altman analysis were used to weigh agreement between devices. RESULTS The mean difference in level-to-touch was 0.04 (95% CI -0.18, 0.27) dermatome levels. Measurement error standard deviation associated with the Neurotip mounted Neuropen and plastic neurological wheel was 1.36 (95% CI 1.26, 1.41) and 1.33 (95% CI 1.26, 1.46) dermatome levels, respectively. The difference in measurement error standard deviation was -0.03 (95% CI -0.16, 0.24). This evidence excludes the possibility, with 95% confidence, of clinically significant bias or measurement error differences between methods. Occasional wide variances in dermatome level were observed with both instruments at the initial assessment only. CONCLUSION The compact plastic neurological wheel is as clinically reliable as the Neurotip mounted Neuropen.
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Husain T, Liu Y, Fernando R, Nagaratnam V, Sodhi M, Tamilselvan P, Venkatesh S, England A, Columb M. How UK obstetric anaesthetists assess neuraxial anaesthesia for caesarean delivery: National surveys of practice conducted in 2004 and 2010. Int J Obstet Anesth 2013; 22:298-302. [DOI: 10.1016/j.ijoa.2013.07.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2013] [Revised: 06/26/2013] [Accepted: 07/07/2013] [Indexed: 10/26/2022]
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Vaughan N, Dubey VN, Wee MY, Isaacs R. A review of epidural simulators: Where are we today? Med Eng Phys 2013; 35:1235-50. [DOI: 10.1016/j.medengphy.2013.03.003] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2012] [Revised: 03/07/2013] [Accepted: 03/09/2013] [Indexed: 11/25/2022]
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Kathirgamanathan A, Douglas MJ, Tyler J, Saran S, Gunka V, Preston R, Kliffer P. Speed of spinal vs general anaesthesia for category-1 caesarean section: a simulation and clinical observation-based study. Anaesthesia 2013; 68:753-9. [DOI: 10.1111/anae.12290] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/17/2013] [Indexed: 11/28/2022]
Affiliation(s)
| | - M. J. Douglas
- Department of Anesthesia; British Columbia Women's Hospital and Health Centre; Vancouver; British Columbia; Canada
| | - J. Tyler
- Department of Anesthesia; British Columbia Women's Hospital and Health Centre; Vancouver; British Columbia; Canada
| | - S. Saran
- Department of Anesthesia; British Columbia Women's Hospital and Health Centre; Vancouver; British Columbia; Canada
| | - V. Gunka
- Department of Anesthesia; British Columbia Women's Hospital and Health Centre; Vancouver; British Columbia; Canada
| | - R. Preston
- Department of Anesthesia; British Columbia Women's Hospital and Health Centre; Vancouver; British Columbia; Canada
| | - P. Kliffer
- Department of Anesthesia; British Columbia Women's Hospital and Health Centre; Vancouver; British Columbia; Canada
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Vaughan N, Dubey VN, Wee MYK, Isaacs R. Towards a realistic in vitro experience of epidural Tuohy needle insertion. Proc Inst Mech Eng H 2013; 227:767-77. [PMID: 23636758 DOI: 10.1177/0954411913483428] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The amount of pressure exerted on the syringe and the depth of needle insertion are the two key factors for successfully carrying out epidural procedure. The force feedback from the syringe plunger is helpful in judging the loss of pressure, and the depth of the needle insertion is crucial in identifying when the needle is precisely placed in the epidural space. This article presents the development of two novel wireless devices to measure these parameters to precisely guide the needle placement in the epidural space. These techniques can be directly used on patients or implemented in a simulator for improving the safety of procedure. A pilot trial has been conducted to collect depth and pressure data with the devices on a porcine cadaver. These measurements are then combined to accurately configure a haptic device for creating a realistic in vitro experience of epidural needle insertion.
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Affiliation(s)
- Neil Vaughan
- School of Design, Engineering & Computing, Bournemouth University, Poole, UK
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28
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Halikar VG, Galitzine S, Popat MT. Erreur de côté lors de la réalisation d’un bloc périphérique. ACTA ACUST UNITED AC 2012. [DOI: 10.1016/j.pratan.2012.04.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Cook T. Litigation in anaesthesia: areas of high clinical risk and the National Audit Projects. Br J Anaesth 2012; 109:1005; author reply 1005-6. [DOI: 10.1093/bja/aes405] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
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Kent CD, Mashour GA, Metzger NA, Posner KL, Domino KB. Psychological impact of unexpected explicit recall of events occurring during surgery performed under sedation, regional anaesthesia, and general anaesthesia: data from the Anesthesia Awareness Registry. Br J Anaesth 2012; 110:381-7. [PMID: 23161356 DOI: 10.1093/bja/aes386] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Anaesthetic awareness is a recognized complication of general anaesthesia (GA) and is associated with post-traumatic stress disorder (PTSD). Although complete amnesia for intraprocedural events during sedation and regional anaesthesia (RA) may occur, explicit recall is expected by anaesthesia providers. Consequently, the possibility that there could be psychological consequences associated with unexpected explicit recall of events during sedation and RA has not been investigated. This study investigated the psychological sequelae of unexpected explicit recall of events during sedation/RA that was reported to the Anesthesia Awareness Registry. METHODS The Registry recruited subjects who self-identified as having had anaesthetic awareness. Inclusion criteria were a patient-reported awareness experience in 1990 or later and availability of medical records. The sensations experienced by the subjects during their procedure and the acute and persistent psychological sequelae attributed to this explicit recall were assessed for patients receiving sedation/RA and those receiving GA. RESULTS Among the patients fulfilling the inclusion criteria, medical record review identified 27 sedation/RA and 50 GA cases. Most patients experienced distress (78% of sedation/RA vs 94% of GA). Approximately 40% of patients with sedation/RA had persistent psychological sequelae, similar to GA patients. Some sedation/RA patients reported an adverse impact on their job performance (15%), family relationships (11%), and friendships (11%), and 15% reported being diagnosed with PTSD. CONCLUSIONS Patients who self-reported to the Registry unexpected explicit recall of events during sedation/RA experienced distress and persistent psychological sequelae comparable with those who had reported anaesthetic awareness during GA. Further study is warranted to determine if patients reporting distress with explicit recall after sedation/RA require psychiatric follow-up.
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Affiliation(s)
- C D Kent
- Department of Anesthesiology and Pain Medicine, University of Washington School of Medicine, Box 356540, 1959 NE Pacific Street, Seattle, WA 98195-6540, USA
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Checketts MR. Wash & go - but with what? Skin antiseptic solutions for central neuraxial block. Anaesthesia 2012; 67:819-22. [DOI: 10.1111/j.1365-2044.2012.07263.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
The Department of Health aims to eliminate the use of devices with a Luer connector firstly from 'single shot' neuraxial procedures (April 2012) and subsequently from all neuraxial and regional anaesthesia procedures (April 2013). This initiative is important for all anaesthetists, oncologists, paediatricians and neurologists. Once achieved, non-Luer connectors for neuraxial procedures will create one more barrier to wrong-route errors. The period until full implementation and market stability remains problematic. Avoidance of unintended consequences requires professional and individual attention to detail. Considerable progress has been made by manufacturers in the last year in improving the quality and range of equipment available, but despite this not all the necessary equipment is available and there remains a lack of independent evaluation, which is urgently needed to enable clinicians to judge the absolute and relative performance of different connectors. Initial evaluation of devices with new connectors can (and should) take place in a laboratory with rigs and manikins, with patient-based evaluation following after the results of the technical and usability evaluations are available. A structured evaluation of all five current connectors is urgently needed. Non-Luer connectors, however successful, will not create barriers to several type of wrong-route error and solutions to these should also be actively sought. It is clear that the initiative has been more complex than the Health Select Committee, the National Patient Safety Agency and the External Reference Group anticipated, but while there is still much work to be done, we should acknowledge that much progress has been made.
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Affiliation(s)
- T M Cook
- Royal United Hospital, Bath, UK.
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Toledo P. What’s new in obstetric anesthesia: the 2011 Gerard W. Ostheimer lecture. Int J Obstet Anesth 2012; 21:68-74. [DOI: 10.1016/j.ijoa.2011.11.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2011] [Accepted: 11/07/2011] [Indexed: 01/22/2023]
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Bibliography. Obstetric and gynaecological anesthesia. Current world literature. Curr Opin Anaesthesiol 2011; 24:354-6. [PMID: 21637164 DOI: 10.1097/aco.0b013e328347b491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Picard J, Ross-Anderson D. Neurological deficit after a peripheral regional anaesthetic: flying on instruments, the black box, crash investigation and other aeronautics. Anaesthesia 2011; 66:435-8. [DOI: 10.1111/j.1365-2044.2011.06760.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Fortuna A. Jonnesco: one century of thoracic spinal anesthesia history. Rev Bras Anestesiol 2011; 61:128-34; author reply 130-7. [PMID: 21334515 DOI: 10.1016/s0034-7094(11)70014-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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JONNESCO: One Century of Thoracic Spinal Anesthesia History. Braz J Anesthesiol 2011. [DOI: 10.1016/s0034-7094(11)70015-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Cook TM. Correspondence: Litigation related to regional anaesthesia: careful reading and interpretation needed. Anaesthesia 2010; 65:958-9; author reply 959-60. [DOI: 10.1111/j.1365-2044.2010.06469.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
IMPORTANCE OF THE FIELD Systemic toxicity, usually from overdose or intravascular dose, is feared because it mainly affects the heart and brain, and may be acutely life-threatening. AREAS COVERED IN THIS REVIEW Pharmacological studies of local anesthetic toxicity have largely been reviewed primarily relating to the evaluation of ropivacaine and levobupivacaine during the past decade. This review/opinion focuses more on the principles and concepts underlying the main models used, from chemical pharmacological and pharmacokinetic perspectives. WHAT THE READER WILL GAIN Research models required to produce pivotal toxicity data are discussed. The potencies for neural blockade and systemic toxicity are associated across virtually all models, with some deviations through molecular stereochemistry. These models show that all local anesthetics can produce direct cardiovascular system toxicity and CNS excitotoxicity that may further affect the cardiovascular system response. Whereas the longer-acting local anesthetics are more likely to cause cardiac death by malignant arrhythmias, the shorter-acting agents are more likely to cause cardiac contraction failure. In most models, equi-anesthetic doses of ropivacaine and levobupivacaine are less likely to produce serious toxicity than bupivacaine. TAKE HOME MESSAGE Of the various models, this reviewer favors a whole-body large animal preparation because of the comprehensive data collection possible. The conscious sheep preparation has contributed more than any other, and may be regarded as the de facto 'standard' experimental model for concurrent study of local anesthetic toxicity ± pharmacokinetics, using experimental designs that can reproduce the toxicity seen in clinical accidents.
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Affiliation(s)
- Laurence E Mather
- The University of Sydney, Royal North Shore Hospital, Department of Anaesthesia & Pain Management, St Leonards, Sydney 2065, Australia.
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Girard T, Schneider MC. Category-1 caesarean section: when time matters. Anaesthesia 2010; 65:659-60. [PMID: 20642521 DOI: 10.1111/j.1365-2044.2010.06427.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Cook TM, Scott S, Mihai R. Litigation related to airway and respiratory complications of anaesthesia: an analysis of claims against the NHS in England 1995-2007. Anaesthesia 2010; 65:556-563. [DOI: 10.1111/j.1365-2044.2010.06331.x] [Citation(s) in RCA: 106] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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