Fritzlen Tracie, Kremer Michael, Biddle Chuck
Virginia Commonwealth University, Department of Nurse Anesthesia, Richmond, VA, USA.
AANA J. 2003 Oct;71(5):347-52.
Anesthesia-associated nerve injury is a common cause of patient morbidity and litigation. To identify factors associated with perioperative nerve injuries and rationalize preventive strategies, 44 cases from the American Association of Nurse Anesthetists (AANA) Foundation Closed Malpractice Claims Database pertaining to nerve injuries in which nurse anesthetists provided care were analyzed. Emerging patterns and themes related to the development of injury were identified. The database is a collection of medical liability claims filed against CRNAs insured by the St Paul Fire and Marine Insurance Company; 44 claims of anesthesia-related nerve injury were analyzed. The most common injury was to the brachial plexus (15 [34%]), followed by ulnar nerve injury (7 [16%]), radial nerve injury (5 [11%]), peroneal nerve injury (4 [9%]), paraplegia (4 [9%]), lumbosacral injury (3[7%]), and a variety of "other" injuries (8[18%]). These numbers and percentages total more than 44 (100%) as some patients incurred multiple injuries. Documentation on the anesthesia record of the use of intraoperative protective padding and patient position was lacking or inadequate in a majority of the claims. Effective strategies for the prevention of nerve injury during anesthesia are reviewed. Abnormal body habitus, several disease states, anesthesia technique, improper positioning, lack of adequate padding, and tourniquet use have been implicated as risk factors.
麻醉相关神经损伤是患者发病和引发诉讼的常见原因。为了确定围手术期神经损伤的相关因素并使预防策略合理化，对美国麻醉护士协会（AANA）基金会封闭医疗事故索赔数据库中44例由麻醉护士提供护理的神经损伤病例进行了分析。确定了与损伤发生相关的新出现的模式和主题。该数据库收集了针对圣保罗火灾及海运保险公司承保的麻醉护士提出的医疗责任索赔；分析了44例与麻醉相关的神经损伤索赔。最常见的损伤是臂丛神经损伤（15例[34%]），其次是尺神经损伤（7例[16%]）、桡神经损伤（5例[11%]）、腓总神经损伤（4例[9%]）、截瘫（4例[9%]）、腰骶部损伤（3例[7%]）以及各种“其他”损伤（8例[18%]）。由于一些患者发生了多处损伤，这些数字和百分比的总和超过了44（100%）。在大多数索赔中，麻醉记录中缺乏或没有充分记录术中使用保护性衬垫和患者体位的情况。本文综述了麻醉期间预防神经损伤的有效策略。异常体型、几种疾病状态、麻醉技术、体位不当、缺乏足够的衬垫以及使用止血带都被认为是危险因素。
