Reducing Anaesthetic Risk

From Episode 173 on the Surgery Feed. With Dr Kenneth Joubert.

Anaesthetist and critical care enthusiast Dr Kenneth Joubert helped me unpack a talk he gave on what we can do to reduce anaesthetic risk. Here are a couple of standout facts that got my attention: 

• The data tells us that the majority of anaesthetic deaths happen AFTER recovery. Ie, once you unplug your patient and sigh a sigh of relief, and move on to the next thing. 

• A few contributing factors that I didn’t know about:

  • The patient that is doing well while intubated and on 100% oxygen might not be that great once it’s extubated and on room air. 

  • There is a phenomenon called ‘nitrogen stenting’ of the alveolus in the normal lung on room air, where the alveolus stays partially ‘inflated’ by nitrogen gas, even when all of the oxygen has been absorbed out of an alveolus. But put your patient on 100% oxygen for a few minutes, and very quickly there’s no nitrogen in the alveolus. In this scenario, if ventilation is less than ideal, the body will suck up all of that oxygen, causing the alveolus to collapse. (Absorption atelectasis). Now, take that patient off 100% oxygen and pop in a cage, and you can see why there might be problems.

  • Nobody’s watching. We anaesthetise a patient, and in doing so compromise its ventilation and oxygenation ability. But we watch them very carefully for most of the procedure, so it’s all good… except for the important bit when they are actually most at risk, when we often just leave them in a cage by themselves. 

• A study that has been going since the 1960’s tells us that the introduction of a new anaesthetic agent hasn't really reduced human anaesthetic mortality since that study started. What has made a difference however is advances in monitoring.

“Drugs don't make a difference. Choose whatever you want to, but look after your patients.”

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