Risk Of Anesthesia-related Complications Research Articles

Incidence of Complications in Obese Patients Undergoing Elective Spine Surgery Under General Anesthesia: A Retrospective Study

Abstract Background The prevalence of obesity has been increasing worldwide. Simultaneously, the number of obese patients undergoing anesthesia and the risk of anesthesia-related complications are increasing. Our study aimed to identify the incidence of intraoperative anesthetic complications in obese patients undergoing elective spine surgery. Methods Electronic medical records of patients with a body mass index (BMI) ≥ 30 kg/m2 who underwent elective spine surgery at the Neurological Institute of Thailand between January 2018 and December 2020 were retrospectively reviewed. The primary outcome was the incidence of five anesthetic adverse events: difficult intubation, oxygen desaturation, hypotension, major adverse cardiac and cerebrovascular events (MACCE), and pressure skin lesions. Logistic regression was used for statistical analysis. Results A total of 165 obese patients' medical records were analyzed. Their mean age was 56.8 ± 11.9 years, and median BMI (interquartile range) was 32.04 kg/m2 (31.11–34.69 kg/m2). Fifty-one patients (30.9%) experienced adverse events. Six patients (3.6%) with class 3 obesity had anesthetic complications. The most common adverse event was intraoperative hypotension (26.7%), followed by pressure skin lesions (4.2%), intraoperative oxygen desaturation (1.2%), and MACCE (0.6%). No difficult intubations or deaths occurred. Conclusion The incidence of overall intraoperative anesthetic complications in obese patients undergoing spine surgery was 30.9%, and class 3 obesity was an independent risk factor for these complications. Consequently, well-trained, vigilant, and experienced anesthesiologists should manage anesthesia in these patients.

Risk of anesthesia-related complications in draft horses: a retrospective, single-center analysis

ObjectiveTo report anesthetic-related complications and determine risks associated with anesthesia in draft horses. Study designRetrospective study. AnimalsA total of 401 anesthetic records for draft horse breeds that underwent general anesthesia from January 2010 through December 2020 were reviewed; horses euthanized during general anesthesia were excluded. MethodsDemographics, perioperative drugs used, procedure type and duration, time to extubation, number of attempts to stand, use of sling in recovery and perioperative morbidity and mortality were investigated. Morbidity and mortality statistical evaluation included univariable logistic regression analysis and ordinal regression analysis. ResultsAmerican Society of Anesthesiologists (ASA) status I–II, ASA III–V and total mortality rate for all cases was 0.69% (2/288), 6.19% (7/113) and 2.24% (9/401), respectively, with Belgian horses being overrepresented (6/9). Cardiac arrest occurred in six out of nine horses that died without euthanasia, and five out of six of these horses underwent colic surgery. Factors associated with increased mortality risk included ASA status of III–V, increased body weight, emergency status and horses presenting for colic. Hypotension, hypercarbia and hypoxemia occurred in 56% (224/401), 46% (186/401) and 14% (58/401) of horses, respectively. During recovery from anesthesia, lighter horses and horses undergoing shorter anesthetic procedures were more likely to be successful on the first or second attempt to stand and were less likely to require a sling in recovery. Conclusions and clinical relevanceDraft horses undergoing general anesthesia had a higher mortality rate than previously reported for all types and breeds of horses.

Lateral Patient Positioning for Pilon and Trimalleolar Ankle Fractures

Category:Ankle; TraumaIntroduction/Purpose:Preoperative planning for pilon and trimalleolar ankle fractures can be difficult. Due to fracture complexity, staged open reduction and internal fixation (ORIF) is performed, resulting in two surgeries. For other situations, definitive fixation occurs with one surgery. However, patients require both prone and supine positioning in order to address all fracture components. Repositioning, re-prepping and re-draping adds to operating room (OR) time and time under anesthesia, increasing the risk for anesthesia related complications. Additionally, repositioning the patient can potentially increase fluoroscopy time and radiation exposure to the patient. Lateral patient positioning obviates many of these concerns. Our study goal was to assess the safety and effectiveness of lateral positioning for pilon and trimalleolar ankle fracture ORIF compared with patients placed in standard positioning (i.e supine/prone).Methods:This was a retrospective cohort analysis of 41 patients who underwent operative fixation of a pilon or trimalleolar ankle fracture at a single institution level 1 trauma center. This study compared outcome data for those undergoing the procedure in lateral positioning (n=31) vs. standard (prone/supine) positioning (n=10). Exclusion criteria included pregnant women, prisoners, patients with less than 6 weeks of follow-up, previous or bilateral pilon or ankle fracture surgery or patients treated with limited internal fixation and external fixation. Variables collected included patient demographics, time to union, time to weightbearing, complications and any repeat surgeries. Additionally, chart review was performed analyzing OR time, fluoroscopy time and radiation dose to patient.Results:The patients fixed in the lateral position underwent significantly less time in the OR and subsequent time under anesthesia (p= 0.02). The average OR time in the lateral positioning group was 160 minutes (min) (range: 65-234 min). The average OR time in the standard positioning group was 193 minutes (range: 143- 263 min). Fluoroscopy time was less in the lateral group compared with the standard group (1.47 vs 2.09 min), though this was not statistically significant. Mean patient radiation dose was less in the lateral position group, but without statistical significance (3.22 vs 3.66 mGy). Compared with the standard positioning group, the lateral group demonstrated a significantly shorter time to weightbearing both in (avg 7.8 weeks) and out (avg 11.8 weeks) of the walking boot (p= 0.01). There were no significant differences in complications or time to fracture union.Conclusion:Our results demonstrated that patients treated in the lateral position progressed in their weightbearing faster without increased risk of complications or delayed union, compared with the standard positioning group. Additionally, perhaps the most intriguing conclusion from our study was that OR time, and therefore time under anesthesia was significantly improved with lateral positioning. Fluoroscopic time and radiation dose exposure were also found to be less on average in the lateral positioning group. Our study suggests that lateral positioning for ORIF of pilon or trimalleolar fractures may not only improve patient safety but also reliably lead to acceptable patient outcomes.

Abstract PR352

: According to WHO, by 2050 it is expect that the number of elderly population would be about 1.5 billion, representing 16% of world’s population. The figure of older patient undergoing surgical procedures is also increasing. Nevertheless, the risk of anesthesia related complications and death is significantly elevated in patient over the age 55-64 and highest in patient over 85 years. Aging is increasingly recognized as a distinctive field of health that associated with decreased physiological reserve and subsequent vulnerability of the patient to risk of stress induced complications. Forecasting post-operative outcomes in elderly patients undergoing surgery is not an easy task, being able to accurately predict who will not be able to do well after surgery would greatly assist in the decision to undergo surgery. Frailty is one of the main health problems, though the concept is almost universally established, its operational description remains debated. Moreover it is often mistakenly applied interchangeably with co-morbidity and disability. Indeed, frailty is a dynamic state leading to loss in one or more field of human functioning (physical, psychological, and social), which increases the risk of adverse outcomes such as falls, hospitalization, disability and death. Recent evidence has emerged suggesting that many chronic diseases cause changes in the human body that are similar to those traditionally attributed to aging. Diabetes, HIV, and cancer are associated with accelerated decline of muscle mass, relative increase in adipose tissue and increments of basic metabolic rate. There are different ways of assessing frailty, however, frailty index widely use in clinical practice. In addition, the seven frailty characteristics have been found to predict postoperative complication in cardiac and colorectal surgery, The Timed Up-and Go, The Katz Score, The Mini-Cog, The Charlson Index, Anemia of chronic disease, Poor nutrition, and the geriatric syndrome of fall. Reducing the severity of frailty is believed to provide large benefits for individuals, their families and for the society. Clinicians should specifically identify and target the dimensions of frailty with different assessment tools. At this time, from the current published literature, four treatments appear to have potential to manage physical components of frailty: exercise, caloric and protein support, vitamin D and reduction of poly-pharmacy. It’s important that clinicians familiarize themselves with frailty and assessment criteria as it has a prognostic value,as well as its measure can help to identify any modifiable factors to improve patient surgical outcome Key words: Elderly, frailty, frailty assessment. Disclosure of Interest: None declared

ANESTHETIC MANAGEMENT OF A PATIENT WITH CENTRAL AIRWAY COMPRESSION DUE TO POSTERIOR MEDIASTINAL MASS

Patients with mediastinal masses present unique challenge to anesthesiologists. Patients with anterior mediastinal masses have well documented cases of respiratory or cardiovascular collapse during anesthesia and in postoperative period. Masses in the posterior mediastinum have been traditionally regarded to carry a significantly lower risk of anesthesia related complications but cases of near fatal cardiorespiratory complications have been reported. We describe anesthetic management of a patient with posterior mediastinal mass compressing the trachea and the left main bronchus presented for left thoracotomy and tumor excision. The patient experienced pain and cough, and exhibited positional dyspnea. Airway was successfully secured with awake nasotracheal intubation and placement of single lumen endobronchial tube.

Urban and Pediatric Hospitals Are Associated with Lower Risk of Anesthesia-Related Complications

Urban and Pediatric Hospitals Are Associated with Lower Risk of Anesthesia-Related Complications