Advertisement

Abstract

Anaesthesia represents a high insurance risk for the medical profession primarily for two reasons. Anaesthetists manipulate the physiology of the cardiovascular and respiratory systems and administer potentially lethal drugs which are not primarily therapeutic; consequently, when a serious accident occurs, it may result in hypoxaemia or ischaemia within seconds or minutes, culminating in death or permanent neurological damage. In addition, because the majority of patients are healthy, even minor morbidity attributed to anaesthesia or the anaesthetist may be regarded as unacceptable to the patient, even though more serious forms of morbidity which are perceived as an inevitable complication of surgery may be tolerated without complaint.

Keywords

Nitrous Oxide Anaesthetic Agent Anaphylactic Reaction Anaesthetic Drug Cerebral Damage 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Ackers v Wigan Health Authority (1986), referred to in Current Law, March 1986..Google Scholar
  2. 2.
    Adams AP (1975) Techniques of vascular control for deliberate hypotension during anaesthesia. Br J Anaesth 47: 777–792.PubMedCrossRefGoogle Scholar
  3. 3.
    Adams AP, Baird WLM, Sykes MK et al. (1988) Recommendations for standards of monitoring during anaesthesia and recovery. Association of Anaesthetists of Great Britain and Ireland, London.Google Scholar
  4. 4.
    Adams AP, Bickford-Smith PJ, Henville JD et al. (1990) Checklist for anaesthetic machines. Association of Anaesthetists of Great Britain and Ireland, London.Google Scholar
  5. 5.
    Aitkenhead AR (1986) Cerebral protection. Br J Hosp Med 35: 290–298.PubMedGoogle Scholar
  6. 6.
    Aitkenhead AR (1988) Regional and local anaesthetics and spinal narcotics for postoperative pain management. Curr Opin Anaesthesiol 1: 352–358.Google Scholar
  7. 7.
    Aitkenhead AR (1990) Awareness during anaesthesia: what should the patient be told? Anaesthesia 45: 351–352.PubMedCrossRefGoogle Scholar
  8. 8.
    Alexander SC, Smith TC, Strobel G, Stephen GW, Wollman H (1968) Cerebral carbohydrate metabolism of man during respiratory and metabolic alkalosis. J Appl Physiol 24: 66–71.PubMedGoogle Scholar
  9. 9.
    Assem ESK (1990) Anaphylactic anaesthetic reactions: the value of paper radioallergosorbent tests for IgE antibodies to muscle relaxants and thiopentone. Anaesthesia 45: 1032–1038.PubMedCrossRefGoogle Scholar
  10. 10.
    Baldo BA, Fisher MM (1983) Substituted ammonium ions as allergenic determinants in drug allergy. Nature 306: 262–264.PubMedCrossRefGoogle Scholar
  11. 11.
    Blacher RS (1975) On awakening paralysed during surgery. JAMA 234: 67–68.PubMedCrossRefGoogle Scholar
  12. 12.
    Bonsu AK, Stead AL (1983) Accidental cross-connexion of oxygen and nitrous oxide in an anaesthetic machine. Anaesthesia 38: 767–769.PubMedCrossRefGoogle Scholar
  13. 13.
    Brahams D (1990) Medicine and the law. Two anaesthetists convicted of manslaughter. Lancet 336: 430–431.CrossRefGoogle Scholar
  14. 14.
    Brierley JK, French JM, Cartlidge NEF (1991) A comparison of the neurological and neuropsychological sequelae in patients undergoing different types of cardiopulmonary bypass surgery. (In press).Google Scholar
  15. 15.
    Buck H, Devlin HB, Lunn JN (1987) The report of a confidential enquiry into perioperative deaths. Nuffield Provincial Hospitals Trust, London.Google Scholar
  16. 16.
    Cole AGH, Thompson JB, Fodor IM, Baker AB, Sear JW (1983) Anaesthetic machine hazard from the Selectatec block. Anaesthesia 38: 175–177.PubMedCrossRefGoogle Scholar
  17. 17.
    Crawford JS (1984) Principles and practice of obstetric anaesthesia. Blackwell Scientific Publications, Oxford, p 297.Google Scholar
  18. 18.
    Eichhorn JH (1989) Prevention of intraoperative anesthesia accidents and related severe injury through safety monitoring. Anesthesiology 70: 572–577.PubMedCrossRefGoogle Scholar
  19. 19.
    Faulkner A (1989) Incidence of fatal reactions to commonly used anaesthetic drugs. Letter from Ledger Bennett Public Relations Ltd. to Dame Jill Knight MP, October 26, 1989.Google Scholar
  20. 20.
    Fisher MMcD (1990) Medico-legal aspects of anaphylaxis. J Med Defence Union, Spring: 4-5.Google Scholar
  21. 21.
    Fisher MMcD, Baldo BA (1984) Anaphylactoid reactions during anaesthesia. Clin Anaesthesiol 2: 677–692.Google Scholar
  22. 22.
    Gaba DM, DeAnda A. A comprehensive anesthesia simulation environment: re-creating the operating room for research and training. Anesthesiology 69: 387-394.Google Scholar
  23. 23.
    Garcia JH, Conger KA (1981) Ischemic brain injuries: structural and biochemical effects. In: Grenvik A, Safar P (eds) Brain failure and resuscitation. Churchill Livingstone, New York, pp 35–54 (Clinics in critical care medicine, vol 2).Google Scholar
  24. 24.
    Hanning CD, Kruchek D, Chunara A (1987) Preferential oxygen leak — an unusual case. Anaesthesia 42: 1329–1330.PubMedCrossRefGoogle Scholar
  25. 25.
    Hargrove RL (1987) Awareness under anaesthesia. J Med Defence Union, Spring: 9-11.Google Scholar
  26. 26.
    Harle DG, Baldo BA, Fisher MM (1984) Detection of IgE antibodies to suxamethonium after anaphylactoid reactions during anaesthesia. Lancet ii: 930–932.CrossRefGoogle Scholar
  27. 27.
    Harris TJB, Brice DD, Hetherington RR, Utting JE (1971) Dreaming associated with anaesthesia: the influence of morphine premedication and two volatile adjuvants. Br J Anaesth 43: 172–178.PubMedCrossRefGoogle Scholar
  28. 28.
    Hutchinson R (1960) Awareness during surgery. Br J Anaesth 33: 463–469.CrossRefGoogle Scholar
  29. 29.
    Kelbie D (1989) Sheriff D. Kelbie, Sheriffdom of Grampian, Highlands and Islands Determination given on 9 May 1989 at Aberdeen.Google Scholar
  30. 30.
    Kolata GB, Marx JL (1976) Epidemiology of heart diseases: searches for causes. Science 194: 509–511.PubMedCrossRefGoogle Scholar
  31. 31.
    Levinson BW (1965) States of awareness during general anaesthesia. Br J Anaesth 67: 544–546.CrossRefGoogle Scholar
  32. 32.
    Lindop MJ (1975) Complications and morbidity of controlled hypotension Br J Anaesth 47: 799–803.PubMedCrossRefGoogle Scholar
  33. 33.
    Liu D, Thorp S, Graham S, Aitkenhead AR (1990) Incidence of recall of awareness during anaesthesia for non-obstetric surgery. Br J Anaesth 65: 575–576.Google Scholar
  34. 34.
    Lunn JN, Mushin WW (1982) Mortality associated with anaesthesia. Nuffield Provincial Hospitals Trust, London.Google Scholar
  35. 35.
    McKenna T, Wilton TNP (1973) Awareness during endotracheal intubation. Anaesthesia 28: 599–602.PubMedCrossRefGoogle Scholar
  36. 36.
    Millar K (1989) Recall, recognition and implicit memory for intra-anaesthetic events. In: Jones JG (ed) Depth of anaesthesia. Baillière Tindall, London, pp 487–510 (Baillière’s clinical anaesthesiology: international practice and research, vol 3.Google Scholar
  37. 37.
    Moir DD (1976) Obstetric anaesthesia and analgesia. Baillière Tindall, London, p 145.Google Scholar
  38. 38.
    Nimmo WS, Aitkenhead AR, Clarke RSJ et al. (1990) Anaphylactic reactions associated with anaesthesia. Association of Anaesthetists of Great Britain and Ireland, London.Google Scholar
  39. 39.
    Noble DW, Yap PL (1989) Screening for antibodies to anaesthetics. No case for doing it yet. Br Med J 299: 2.CrossRefGoogle Scholar
  40. 40.
    Notcutt WG, Morgan RJM (1990) Introducing patient-controlled analgesia for postoperative pain control into a district general hospital. Anaesthesia 45: 406–408.CrossRefGoogle Scholar
  41. 41.
    Nunn JF (1987) Applied respiratory physiology, 3rd edn. Butterworth, London.Google Scholar
  42. 42.
    Plum F, Posner JB (1982) The diagnosis of stupor and coma, 3rd edn. FA Davis Company, Philadelphia.Google Scholar
  43. 43.
    Safar P (1981) Resuscitation after brain ischemia. In: Grenvik A, Safar P (eds) Brain failure and resuscitation. Churchill Livingstone, New York, pp 155–184 (Clinics in critical care medicine, vol 2).Google Scholar
  44. 44.
    Schwilden H (1989) Use of the median EEG frequency and pharmacokinetics in determining depth of anaesthesia. In: Jones JG (ed) Depth of anaesthesia. Baillière Tindall, London, pp 603–621 (Baillière’s clinical anaesthesiology: international practice and research, vol 3).Google Scholar
  45. 45.
    Sear JW (1983) General kinetic and dynamic principles and their application to continuous infusion anaesthesia. Anaesthesia 38(Suppl): 10–25.PubMedCrossRefGoogle Scholar
  46. 46.
    Sebel PS (1989) Somatosensory, visual and motor evoked potentials in anaesthetized patients. In: Jones JG (ed) Depth of anaesthesia. Baillière Tindall, London, pp 587–602 (Baillière’s clinical anaesthesiology: international practice and research, vol 3).Google Scholar
  47. 47.
    Shaw PJ, Bates D, Cartlidge NEF et al. (1986) Neurological complications of coronary artery bypass surgery: six-month follow-up study. Br Med J 293: 165–167.CrossRefGoogle Scholar
  48. 48.
    Siesjo BK, Ljunggren B (1973) Cerebral energy reserves after prolonged hypoxia and ischemia. Arch Neurol 29: 400–407.PubMedGoogle Scholar
  49. 49.
    Smith GB, Hirsch NP, Ehrenwerth J (1986) Placement of double-lumen endobronchial tubes: correlation between clinical impressions and bronchoscopic findings. Br J Anaesth 58: 1317–1320.PubMedCrossRefGoogle Scholar
  50. 50.
    Stoelting RK, Longnecker DE, Eger EI (1970) Minimum alveolar concentrations in man on awakening from methoxyflurane, halothane, ether and fluroxene anesthesia: MAC awake. Anesthesiology 33: 5–9.PubMedCrossRefGoogle Scholar
  51. 51.
    Thompson PW (1987) Safer design of anaesthetic equipment. Br J Anaesth 59: 913–921.PubMedCrossRefGoogle Scholar
  52. 52.
    Thornton C, Konieczko K, Jones JG, Jordan C, Doré CJ, Heneghan CPH (1988) Effect of surgical stimulation on the auditory evoked response. Br J Anaesth 56: 372–378.CrossRefGoogle Scholar
  53. 53.
    Thorp JM, Railton R (1982) Hypoxia due to air in the oxygen pipeline: a case for oxygen monitoring in theatre. Anaesthesia 37: 683–687.PubMedCrossRefGoogle Scholar
  54. 54.
    Tinker JH, Dull DL, Caplan RA, Ward RJ, Cheney FW (1989) Role of monitoring devices in prevention of anesthetic mishaps: a closed claim analysis. Anesthesiology 71: 541–546.PubMedCrossRefGoogle Scholar
  55. 55.
    Tunstall ME (1977) Detecting wakefulness during general anaesthesia for Caesarean section. Br Med J i: 1321.CrossRefGoogle Scholar
  56. 56.
    Utting JE (1987) Pitfalls in anaesthetic practice. Br J Anaesth 59: 877–890.PubMedCrossRefGoogle Scholar
  57. 57.
    Vacanti D, Van Houten RJ, Hill RC (1970) A statistical analysis of the relationship of physical status to postoperative mortality in 68386 cases. Anesth Anal 49: 564–567.CrossRefGoogle Scholar
  58. 58.
    Ward CS (1985) The continuous flow anaesthetic machine. In: Ward CS, Anaesthetic equipment, 2nd edn. Baillière Tindall, London, pp 104–121.Google Scholar
  59. 59.
    Watkins J (1989) Second report from an anaesthetic advisory service. Anaesthesia 44: 157–159.PubMedCrossRefGoogle Scholar
  60. 60.
    Whitby LG (1974) Screening for disease. Definitions and criteria. Lancet i: 819–822.CrossRefGoogle Scholar
  61. 61.
    White DC (1987) Anaesthesia: a privation of the senses. An historical introduction and some definitions. In: Rosen M, Lunn JN (eds) Consciousness awareness and pain in general anaesthesia. Butterworth, London, pp 1–9.Google Scholar
  62. 62.
    Williams KN, Nunn JF (1989) The oesophageal detector device. A prospective trial on 100 patients. Anaesthesia 44: 412–414.PubMedCrossRefGoogle Scholar
  63. 63.
    Wilson SH, Vaughan RW, Stephen CR (1975) Awareness, dreams and hallucinations associated with general anesthesia. Anesth Analg 54: 609–616.PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag London Limited 1991

Authors and Affiliations

  • A. R. Aitkenhead

There are no affiliations available

Personalised recommendations