Metzner Julia, Posner Karen L, Domino Karen B
Department of Anesthesiology and Pain Medicine, University of Washington School of Medicine, Seattle, Washington 98195-6540, USA.
Curr Opin Anaesthesiol. 2009 Aug;22(4):502-8. doi: 10.1097/ACO.0b013e32832dba50.
A growing number of procedures are performed outside the operating room. In spite of their relatively noninvasive nature, serious adverse outcomes can occur. We analyzed claims from 1990 and later in the American Society of Anesthesiologists Closed Claims database to assess patterns of injury and liability associated with claims from anesthesia in remote locations (n = 87) compared with claims from operating room procedures (n = 3287).
Compared with operating room claims, remote location claims involved older and sicker patients (P < 0.01), with 50% of remote location claims involving monitored anesthesia care. The proportion of claims for death was increased in remote location claims [54 vs. 29% (operating room claims), P < 0.001]. Respiratory damaging events were more common in remote location claims (44 vs. 20%, P < 0.001), with inadequate oxygenation/ventilation the most common specific event (21 vs. 3% in operating room claims, P < 0.001). Remote location claims were more often judged as being preventable by better monitoring (32 vs. 8% for operating room claims, P < 0.001).
Data from the American Society of Anesthesiologists, Closed Claims database suggest that anesthesia at remote locations poses a significant risk for the patient, particularly related to oversedation and inadequate oxygenation/ventilation during monitored anesthesia care. Similar anesthesia and monitoring standards and guidelines should be used in all anesthesia care areas.
越来越多的手术在手术室以外进行。尽管这些手术相对无创，但仍可能发生严重不良后果。我们分析了美国麻醉医师协会封闭索赔数据库中1990年及以后的索赔数据，以评估与偏远地区麻醉索赔（n = 87）相关的损伤模式和责任，与手术室手术索赔（n = 3287）进行比较。
与手术室索赔相比，偏远地区索赔涉及年龄更大、病情更重的患者（P < 0.01），其中50%的偏远地区索赔涉及监护下麻醉。偏远地区索赔中的死亡索赔比例增加[54%对29%（手术室索赔），P < 0.001]。呼吸损害事件在偏远地区索赔中更常见（44%对20%，P < 0.001），氧合/通气不足是最常见的具体事件（手术室索赔中为21%对3%，P < 0.001）。偏远地区索赔更常被判定通过更好的监测可预防（手术室索赔为32%对8%，P < 0.001）。
美国麻醉医师协会封闭索赔数据库的数据表明，偏远地区的麻醉对患者构成重大风险，特别是在监护下麻醉期间与过度镇静和氧合/通气不足有关。所有麻醉护理区域应采用相似的麻醉和监测标准及指南。
