Anesthesia Safety

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By Robert F. Early, Jr., M.D.

As anesthesiologists, we have worked hard during the last century to improve the anesthesia experience for patients and are considered one of the pioneers in the field of medical patient safety. Below is information that highlights some of those efforts.

American Society of Anesthesiologists
Timeline of anesthesia-related complications and improvements
A commitment to improving patient safety
Patient Safety Highlights

American Society of Anesthesiologists (ASA)

  • ASA website 
    • Vigilance – the motto of the American Society of Anesthesiologists and hallmark of safe patient care

 

Timeline of Anesthesia-Related Complications and Improvements

    • 1950s – principal intraoperative complications were hypotension, hypoventilation and hypoxia; resultant improvements in cardiac resuscitation, more rational transfusion therapy, increased use of recovery rooms, and more efficient use of mechanical ventilators.
    • 1960s – significant safety advantages of a Post Anesthesia Care Unit (PACU); reduction in anesthesia-related deaths attributed to an increase in the number of qualified staff and the degree of supervision.
    • 1970s – mortality rate increased with the severity of disease and the need for emergent operations; four specific changes occurred:
      • 1) continued improvement in routine monitoring,
      • 2) increase in the ratio of attending anesthesiologists to residents,
      • 3) decrease in the case load per anesthesiologist, and
      • 4) introduction of Intensive Care Units (ICU’s)
    • 1980s – studies began to be performed on a national basis; major complications occurred more frequently in older patients, those undergoing emergency operations, and those with more extensive comorbidities as measured by the ASA physical status classification; postanesthesia respiratory depression was the largest cause of death and coma that were totally attributable to anesthesia; death rate was inversely related to seniority of the operating surgeon and to preoperative preparation of the patient.

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A Commitment to Improving Patient Safety

  • Few professional societies or groups have demonstrated a visible commitment to reducing errors in health care and improving patient safety, with one exception: anesthesiologists (from a 1999 report by the Institute of Medicine)
  • During the past 30 years, patient deaths due to anesthesia have declined from one for every 10,000 cases to one per 200,000 to 300,000 cases

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Patient Safety Highlights

  • In 1985, with the financial assistance of American Society of Anesthesiologists (ASA), the Anesthesia Patient Safety Foundation (APSF) was formed with the mission that “no patient shall be harmed from anesthesia.” APSF is a pioneer, stand-alone organization solely devoted to patient safety with the dramatic success of its efforts based upon attention to early identification of safety problems, supporting and encouraging research, disseminating information, and promoting an emphasis on patient safety in clinical practice.

The most important feature of the APSF effort has been the elevation of patient safety to coequal status with more traditional concerns, such as determining the molecular mechanisms of anesthesia, developing specialized drugs, or managing critically ill patients. The foundation includes in its membership not only physicians but nurses, insurers, lawyers, regulators and representatives from the manufacturing and pharmaceutical industries. A newsletter is published quarterly and the activities of the foundation can be obtained through the website. In 1986, ASA was the first medical specialty to adopt standards of care for its members. Today, more than 40 standards, guidelines and statements developed by the society provide guidance to improve decision-making for anesthesiologists and promote beneficial outcomes for our patients. These standards, along with today’s sophisticated monitoring and anesthesia equipment as well as improved medications and techniques, have contributed enormously toward making anesthesia safer than ever before.

  • Since 1985, ASA has conducted a detailed analysis of closed anesthesia claims (ASA Closed Claims Project). Very little was known about people injured or killed during anesthesia prior to 1985. No United States database existed, so ASA began collecting this information to create an overall picture of how anesthesia accidents tend to occur.

In a short time, an alarming trend showed 40 percent of deaths from anesthesia were related to ventilation failures.

This research contributed to two innovations that between them have dramatically decreased or virtually eliminated death and injury from ventilation failure. One, pulse oximetry, noninvasively measures the patient’s oxygen saturation, and the other, capnography, measures the patient’s exhaled carbon dioxide level.

Also, anesthesia machines have been redesigned to be much safer and anesthesia drugs are much improved as compared to 20 years ago. The Closed Claims Project continues to be active by examining adverse patient outcomes and identifying recurring patterns of injuries, which assist clinicians to more safely care for patients.

New emerging concerns have recently been recognized as the Closed Claims Project continues its valuable work: Postoperative Visual Loss after non-ophthalmic surgery and Nerve Injury after invasive pain management procedures.

  • In health care, safety must be a never-ending quest, particularly as efforts are made to control and reduce costs. Anesthesiologists will continue to work tirelessly to assure our patients remain safe under our care.

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Physicians

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