SAFE PRACTICE OF ANESTHESIA

Abstract

SUMMARY P atients have a right to expect to be safe and protected from harm during their medical care and anaesthesiology has a key role to play improving patient safety perioperatively. To this end we fully endorse the World Federation of Societies of Anaesthesiologists International Standards for a Safe Practice of Anaesthesia.2 Around 230 million patients undergo anaesthesia for major surgery in the world every year. Seven million develop severe complications associated with these surgical procedures from which one million die (200,000 in Europe).1 All involved should try to reduce this complication rate significantly. Anaesthesiology is the key specialty in medicine to take up responsibility for achieving the goals listed below which will notably improve Patient Safety. Anaesthesia is a medical specialty that is particularly concerned with the safety of the patient who is undergoing a surgical procedure. This is a prerequisite in order to provide quality of care, which is based on good clinical practice, on a sound organization, on an agreement on best practice and on adequate communication with other healthcare workers involved. Providing a safe environment for those working in healthcare is at least as important as other factors serving that objective The first and most important component of peri-anesthetic care, including monitoring of the anesthesia delivery system and the patient, is the continuous presence of a vigilant anesthesia professional during anesthesia. In addition to use of monitoring technology, careful continuous clinical observation is required because equipment may not detect clinical deterioration as rapidly as the skilled professional. If an emergency requires the brief temporary absence of the primary anesthesia professional, judgment must be exercised comparing the emergency with the anesthetized patient’s condition and in the selection of the person left responsible for the anesthetic during the temporary absence. An appropriate ‘‘pre-list check,’’ which has been established in each health care institution providing anesthesia services, of the anesthesia system, facilities, equipment, and supplies should be performed prior to the start of each operating list. A failed airway has been defined as three unsuccessful attempts at orotracheal intubation by a skilled practitioner or failure to maintain acceptable oxygen saturation (usually ≥ 90%) in another wise normal patient. Mortality from anesthesia-related procedures frequently can be due to failure to recognize and address airway.