Critical Incidents during Anesthesia and Early Post-Anesthetic Period: A Descriptive Cross-sectional Study
Binod Gautam1, Babu Raja Shrestha1
1Department of Anesthesia and Intensive Care, Kathmandu Medical College, Sinamangal, Kathmandu, Nepal.
JNMA; Journal of the Nepal Medical Association
|May 18, 2020
Summary
Critical incidents during anesthesia are common, even in healthy patients. Anesthesia factors, particularly system and human errors, contribute most frequently to these events, though patient and surgical factors increase severity.
Area of Science:
- Anesthesiology
- Patient Safety
- Healthcare Quality Improvement
Background:
- Peri-operative anesthesia critical incidents pose risks for adverse patient outcomes.
- Studying these incidents is vital for identifying systemic problems and preventing recurrence.
- This study focuses on the frequency of critical incidents during the peri-anesthetic period.
Purpose of the Study:
- To determine the frequency of critical incidents occurring during or within 24 hours of anesthesia.
- To analyze the contributing factors (patient, anesthesia, surgery) and types of errors (system, equipment, human) in these incidents.
- To identify patient and surgical characteristics associated with more severe outcomes.
Main Methods:
- A hospital-based, descriptive, cross-sectional study design.
- Voluntary reporting of incidents during anesthesia or within 24 hours post-operatively for non-cardiac surgery in 2019.
- Data collected on patient demographics, anesthesia/surgery types, incident context, outcome, and attributable factors, analyzed for error contributions.
Main Results:
- A total of 524 incidents were reported from 464 cases.
- Cardiovascular events were the most frequent (65.8%).
- Most incidents occurred in healthy patients (93%) under spinal anesthesia (55.6%), often during obstetric surgery (38.6%) and elective procedures (63%).
- Anesthesia-attributable factors were most common (69.5%), with system (53.8%) and human error (41.7%) being primary contributors.
- Mortality (25 cases) was linked to patient factors, surgical urgency, and general anesthesia.
Conclusions:
- Critical incidents in anesthesia delivery can occur even in low-risk patient populations.
- Patient-related factors and emergency surgery significantly contribute to the occurrence of severe incidents and mortality.
- System and human errors are major contributors to the overall frequency of anesthesia-related critical incidents.
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