oa Southern African Journal of Anaesthesia and Analgesia - Expensive anaesthesia complications : review article
The major, costly, and catastrophic adverse consequences of anaesthesia are reviewed. The American Society of Anesthesiologists' closed claims registry yields valuable insights. The size and success of claims is determined by the standard of care, and extent of injury. Ongoing assessment of the pattern of claims allows determination of high-risk patients and interventions, as well as the formulation of protocols or practice guidelines to reduce risk. Injuries to previously healthy individuals are inevitably more costly. Respiratory mechanisms still account for the majority of serious adverse events. However, the focus has shifted from intubation problems to extubation and the recovery room. Emerging areas of concern are claims that relate to nerve injury, with or without regional anaesthesia, postoperative visual loss, and monitored anaesthesia care and sedation. An area of particular concern, namely spinal-epidural haematoma associated with central neuraxial blockade, is a typical example of the closed claims registry / taskforce / protocol approach. Specific risk factors, such as use of anticoagulants close to the time of performance of the neuraxial block, traumatic technique, elderly patients, and renal dysfunction, have been identified. Protocols have been devised for risk reduction.
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