The Risks and Complications of Anesthesia

Dr.Nazih Nahleh
Dr.Abed menaam Nassour
Dr.Saleh Kanawati
Dr.Bassam Toameh
Dr.Mona Kanso
 The Introduction
• From Greek anaisthesis means ”not sensation”
• Listed in Bailey´s English Dictionary 1721.
• When the effect of ether was discovered”anesthesia” used as a name for the
new phenomenon.
• Anesthesia defined as the abolition of sensation
• Analgesia defined as the abolition of pain
• “Triad of General Anesthesia”
 need for unconsciousness
 need for analgesia
 need for muscle relaxation
Anesthesiologists care for the surgical patient in the
preoperative, intraoperative, and postoperative period .
Important patient care decisions reflect the preoperative
evaluation, creating the anesthesia plan, preparing the
operating room, and managing the intraoperative anesthetic.
• There are 3 main types of anesthesia :
1- General Anesthesia (GA) .
2- Regional Anesthesia (RA): Spinal, Epidural anesthesia and Nerve block .
3- Local Anesthesia (LA).
 Anesthesiologists Preoperatively Perform :
1-Focused clinical examinations .
2-Plan for medical intervention and optimization .
3-↓patient’s and family anxiety and fears .
4-Discuss peri-op care and postop pain control .
5-Laboratory tests and diagnostic studies .
6-Discuss anesthesia risks .
7-Obtain informed consent .
• Every practitioner may face these complications despite acting well.
• May be preventable or unpreventable(sudden death syndrome, fatal
idiosyncratic drug reactions ….) .
• When complications do occur, appropriate evaluation, management,
and documentation are critical in minimizing or eliminating negative
outcomes .
 The Complications of GA
• Perioperative mortality is usually defined as death within 24 h of
surgery .
• It is clear that most perioperative fatalities are due to the patient's
preoperative disease or the surgical procedure.
• The mortality rate attributable primarily to anesthesia appears to have
dropped from 2/3000 to 2/20000 .
• This decrease in anesthesia mortality is due to the availability and
utilization of new monitoring equipment, greater knowledge of
anesthetic physiology and pharmacology, and improved surgical and
medical care .
 The Complications of GA
• Anesthetic-related morbidity are more difficult to determine .
• Estimates suggest that up to 2% of intensive care unit admissions at
any one time are related to anesthetic problems .
• The decision to operate and which form of anesthesia to use should
then be decisions made by the surgeon and anesthetist.
 The Complications of GA
1- Intra-operative complications .
2- post-operative complications .
 Intra-Operative GA complications :
• Anaphylaxis .
• Due to (laryngoscopy – indotracheal tube)
• Aspiration (secretions - blood) and Aspiration pneumonitis.
• Due to anesthetic drugs – hypoxia – hypotension – hypertension –
hypercarbia – hypocarbia – hypothermia – hyperthermia .
• Hypoglycemia – hyperglycemia .
• Less or over fluid infusion .
• Anemia - IHD - MI.
• Hyperthyrodism – hypothyrodism .
• Air or fat embolism .
• Awareness during anesthesia .
 Intra-Operative GA complications :
• Anaphylaxis: in all types of anesthesia .The reaction may vary but
features may include rash, urticaria, bronchospasm, hypotension,
angio-oedema, and vomiting .

• Aspiration pneumonitis: It may occur in spinal anesthesia .

 Intra-Operative GA complications :
Due to laryngoscopy :
• Trauma to lips.
• Trauma to teeth.
• Trauma to tongue.
• Trauma to tonsilar pillar.
• Trauma to epiglottises, vocal cords.
 Intra-Operative GA complications :
Due to endotracheal tube :
• Injury to vocal cords .
• Injury to trachea .
• Blockage of tube (secretions – blood clot – foreign body) .
• Bronchospasm .
 Post-Operative GA complications :
• Pain.
• Nausea and vomiting - up to 30% of patients.
• Respiratory depression.
• Nerve injury - 0.4% in general anaesthesia and 0.1% in regional
anesthesia.
• Backache.
• Headache.
 Post-Operative GA complications :
• Peripheral nerve damage: in all types of anesthesia and results from nerve
compression .The most common cause is prolonged exaggerated position .
The most common nerves affected are the ulnar nerve and the common
peroneal nerve.
 The Important Complications of RA :
• The need for muscle paralysis and ventilation is not usually required
but there is a risk that a high block will impair respiration, meaning that
ventilation will be necessary .
• The results have shown that regional anesthesia is associated with
reduced mortality and reduction in serious complications in comparison
with general anesthesia.
Important complications of regional anesthesia :
• Pain - 25% of patients still experience pain despite spinal anesthesia.
• Post-dural headache from cerebrospinal fluid (CSF) leak.
• Hypotension and bradycardia through blockade of the sympathetic nervous system.
• Itching .
• Limb damage from sensory and motor block.
• Epidural or intrathecal bleed.
• Respiratory failure if block is 'too high'.
• Direct nerve damage.
• Hypothermia.
• Damage to the spinal cord - may be transient or permanent.
• Spinal infection.
• Aseptic meningitis.
• Haematoma of the spinal cord - enhanced by use of LMWH pre-operatively.
• Anaphylaxis.
• Urinary retention.
• Spinal cord infarction.
• Anesthetic intoxication.
 The Specific Complications of RA :
• Post-dural puncture headache: is very common ,may include headache,
photophobia ,vomiting and dizziness .is usually treated with analgesia, bed
rest and adequate hydration and may need blood patch.
• Total spinal block: may need intubation.
• Hypotension: as sympathetic nerves are blocked .Care must be taken in
patients with a cardiac history .
• Neurological deficits .
 The Complications of LA
Important complications of local anesthesia :
• Pain.
• Bleeding and hematoma formation.
• Nerve injury due to direct injury.
• Infection.
• Ischemic necrosis.
The use of ultrasound in LR Anesthesia has
significantly decreased the complication of
peripheral nerve block
 The References

• Miller’s Anesthesia 2015 .

• Morgan and Mikhail’s clinical Anesthiology .5 th edition .