Count down those "very low incidence, but extremely harmful" complications in anesthesia

Anesthesiologists often talk to patients or family members and mention that the main responsibility of anesthesia is to guard the safety of the operation.
Generally, there is no accident, but an accident is a major event; in short, there are only minor operations and no minor anesthesia.

With the development of anesthesia discipline in recent decades, the mortality rate caused by anesthesia has been very low, reaching the level of 1/100,000.
This requires most anesthesiologists to work for a lifetime, and there can be no case of death due to anesthesia.

Although it is extremely rare to encounter deaths caused by anesthesia directly, there are still small-probability complications in anesthesia work, and these complications often bring great harm to patients; this article details those in anesthesia that have "extremely low incidence, but With the complications of “extremely harmful”, we should be vigilant with each other in order to make progress.

01 Malignant hyperthermia (MH) is a panic-stricken malignant hyperthermia.
It is caused by anesthetics and the main manifestation is the enhancement of skeletal muscle metabolism.
It is an autosomal dominant genetic disease.

The signs of MH include tachycardia, increased PetCO2, muscle stiffness, and increased body temperature, all of which are caused by increased metabolism.

It is often triggered by anesthetic drugs such as halothane and succinylcholine.
When the trigger drug is not used, the incidence is about 1/62000; when the trigger drug is used, the incidence rises to 1/4500.

The initial mortality rate of malignant hyperthermia was as high as 60%, but after the early diagnosis and the application of dantrolene, the mortality rate dropped to 1.
4%.

02 Blindness after surgery Blindness after anesthesia is a very rare but serious complication that often occurs after heart, spine, and head and neck surgery.

Perioperative ischemic optic neuropathy (ION) is relatively rare, and the incidence is only about 1/60000~1/125000.
Among them, the perioperative incidence of spine surgery is 0.
03%, followed by heart surgery 0.
086%.

The causes of perioperative blindness include occlusion of the main or branch of the retinal artery, anterior or posterior ischemic optic neuropathy, cortical blindness, and acute glaucoma.

Once the patient complains of eye pain, lack of light perception, complete or partial loss of visual field, decreased visual sensitivity, or disappearance of pupil reflexes, an ophthalmologist must be asked for evaluation immediately.

The main cause of perioperative occlusion of the main trunk or branches of the central retinal artery is pressure on the eye.
Emboli may block the retinal artery during heart surgery.

It is expected that patients with prolonged, prone position, and large blood loss are at higher risk of ischemic optic neuropathy; during spinal surgery, risk factors include men, obesity, Wilson frame, and fluid management.

Preventive measures include: 1.
Avoid direct compression of the eyeball, including a face mask.
It is recommended to fix the head frame with a needle for cervical spine surgery; 2.
The eye should be inspected at least 20 minutes after changing the body position or without external pressure; 3.
Place a mirror below to facilitate intermittent observation ; 4.
Avoid injection into the blood vessel by mistake or affect the eye circulation during intranasal surgery.

03 Epidural hematoma and paraplegia Epidural hematoma often occurs in spinal canal puncture.
If it is not detected and removed in time, it can lead to spinal cord necrosis and permanent neurological deficit; risk factors include difficulty in puncture, needle injury, catheter insertion , Coagulation dysfunction, advanced age and female.

Studies have found that the incidence of epidural hematoma after spinal anesthesia is less than 0.
06/10000, and the incidence of epidural hematoma after epidural anesthesia may be as high as 10 times that of the former.

According to reports, the incidence of intraspinal anesthesia-related paraplegia is about 0.
1/10,000.
The possible causes include direct needle injury and the injection of foreign substances into the cerebrospinal fluid.
Severe hypotension and spinal cord ischemia are also important factors for intraspinal anesthesia leading to paraplegia.

04 Local anesthetic poisoning Generally speaking, the appropriate dose is applied, the administration location is accurate, the local anesthetic is relatively safe, and the probability of poisoning is extremely low; the local anesthetic is mostly accidentally injected into the epidural vena cava in the spinal canal, and the peripheral nerve is blocked.
Hysteresis is often caused by excessive volume or direct vascular injection, and the incidence of local anesthetic poisoning under ultrasound guidance is less than 1/1000.

The systemic toxicity of local anesthetics mainly includes cardiotoxicity, including atrioventricular block, arrhythmia, myocardial depression, cardiac arrest, and brain toxicity, including irritability, lethargy, convulsions and extensive central nervous system depression, and can be accompanied by tinnitus, Metallic taste or numbness around the mouth, hypoxemia and acidosis can aggravate the above-mentioned toxic reactions.

Once the above indications are found, local anesthetic poisoning should be suspected, and all local anesthetic injections should be stopped immediately.
Patients with epilepsy should be given midazolam, and patients with cardiac arrest should be given CPR immediately, and fat emulsions should be prepared for reversal.

05 Intubation-related tracheal stenosis Intubation-related tracheal stenosis mostly occurs in children.
According to reports [1], the most common iatrogenic cause of pediatric laryngotracheal stenosis is pediatric tracheal intubation and pediatric tracheal intubation.
The incidence of stenosis can reach 1% to 8%.

The causes of laryngotracheal stenosis in children after tracheal intubation are mainly divided into endogenous and exogenous.

Endogenous factors are the special anatomy of the neck in children, which can easily cause edema and connective tissue hyperplasia to form stenosis after being stimulated; there are many exogenous factors, such as long-term intubation, multiple intubation or replacement, improper intubation fixation, and excessive air bag pressure High height, irregular sputum suction, and excessive selection of catheters can all cause mechanical damage to the tracheal wall mucosa, resulting in the proliferation of granulation and scar tissue.
In severe cases, tracheo-esophageal fistula may even occur.

06 After arterial pressure measurement, the radial artery is often used to monitor invasive blood pressure in clinical practice.
It is also used safely for coronary catheter inspection and stent placement or used for coronary artery bypass grafting in recent years; radial artery puncture causes permanent limbs Ischemic sequelae are very rare, but once an ischemic event occurs, it should be dealt with immediately.

We often use the Allen test for pre-puncture evaluation, but the 5s threshold of the modified Allen test has a diagnostic accuracy rate of only 80%, and sensitivity and specificity are 76% and 82%; therefore, the modified Allen test can help determine the patient’s acceptable radial Arterial puncture, but can not predict the clinical outcome of arterial blood pressure monitoring after catheterization.

The above is just a list of some of the more familiar and serious complications during anesthesia.
We welcome your corrections and supplements.
Although the incidence is extremely low, the necessary prevention is indispensable, and it is also the best way to prevent us from encountering them in our careers.
, I hope to give you a harvest! References: [1] Li Yixuan, Deng Minxin, Lu Zhongming, et al.
Clinical analysis of laryngotracheal stenosis after tracheal intubation in children[J].
Chinese Otorhinolaryngology-Head and Neck Surgery, 2018, 25(01):59-60.
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