Avoiding Common Anesthesia Errors

AIRWAY AND VENTILATION
Basics
Advanced
Never neglect the basics of airway management
Basics of airway management- Part II (Tips and Tidbits)
Consider PEEP

Advanced: A variety of techniques provide acceptable anesthesia for awake intubation of the airway: ultimately, the most important factors are operator experience and adequate time
Special Cases: A high inspired concentration of oxygen is contraindicated in certain circumstances
Remember that there are special considerations involved with both intubation and chronic airway management of burn patients
Problem solving: Always troubleshoot an increase in peak airway pressure
Plan for an airway fire with every head and neck case

Know how to perform a cricothyroidotomy
Perioperative Issues
Don'ts: Do not overinflate the cuff of the endotracheal tube

Don't under represent the risks associated with the use of a laryngeal mask airway
Do not be intimidated by the placement and use of double-lumen endotracheal tubes
Do not underestimate the difficulty of reintubating a patient who has undergone carotid endarterectomy or cervical spine surgery Do not start the airway management of a Ludwig angina patient until personnel and equipment for a definitive (surgical) airway are assembled

LINES AND ACCESS Basics:Remember that the IV start is your first chance to make a favorable impression on the patient
Never use an intravenous line without palpating and inspecting it visually
Use of ultrasound guidance for cannulation of the central veins improves success rates, decreases number of attempts, and lowers complication rates

Central Lines: Central line placement: never neglect the basics
Approach the use of a pulmonary artery catheter with caution
Avoid technique-related central venous catheter complications by using modern tools

Don'ts: Don't overflush lines

Do not use the subclavian vein for central access of any type in a patient planned for dialysis

Errors: Remember that inadvertent intra-arterial injection is not rare
Avoid errors in invasive blood pressure measurement
Remember that loss of a patent hemodialysis fistula in the perioperative period is a serious event for the patient and requires immediate communication with the surgeons

FLUIDS, RESUSCITATION, AND TRANSFUSION Fluids: Hypertonic saline: the "solution" to the solution problem?
Remember that the synthetic colloid solutions have distinct properties and risk/benefit ratios

Resuscitation: Protect the kidneys, not the "UOP"
Do not treat lactic acidosis with bicarbonate
Consider the use of tris-hydroxymethyl aminomethane (THAM)to treat refractory or life-threatening metabolic acidosis
Use the principles of "damage control anesthesia" in the care of the massively bleeding patient and ask the surgeons to implement "damage control surgery" if necessary
"Routine" Labor and Delivery Learn from the care of the combat victim: ask the surgeons to consider damage control surgery for the bleeding patient

Transfusion: Know what screening tests are performed on volunteer donor blood
Transfusion of packed red blood cells requires a careful riskbenefit analysis

MEDICATIONS Perioperative issues:

INTRAOPERATIVE AND PERIOPERATIVE Basics:

REGIONAL ANESTHESIA

PACU

PEDIATRIC ANESTHESIA

NEUROANESTHESIA

CARDIAC ANESTHESIA

OB ANESTHESIA

PAIN MEDICINE

HUMAN FACTORS

LEGAL

PROFESSIONAL PRACTICE

CODING AND PAYMENT-MAKE SURE YOU GET PAIDCOMMENCEMENT

Index