Department of Anesthesiology, College of Medicine, University of Kentucky, N-202, UKMC, 800 Rose St., Lexington, KY, 40536-0293, USA.
Can J Anaesth. 2013 Feb;60(2):111-8. doi: 10.1007/s12630-012-9852-z. Epub 2012 Dec 20.
This brief review provides an overview and, importantly, a context perspective of relevant current practical issues in perioperative patient safety.
The dramatic improvement in anesthesia patient safety over the last 30 years was not initiated by electronic monitors but, rather, largely by a set of behaviours known as "safety monitoring" that were then made decidedly more effective by extending the human senses through electronic monitoring, for example, capnography and pulse oximetry. In the highly developed world, this current success is threatened by complacency and production pressure. In some areas of the developing/underdeveloped world, the challenge is implementing the components of anesthesia practice that will bring safety improvements to parallel the overall current success, for instance, applying the World Federation of Societies of Anaesthesiologists (WFSA) "International Standards for A Safe Practice of Anaesthesia". Generally, expanding the current success in safety involves many practical issues. System issues involve research, effective reporting mechanisms and analysis/broadcasting of results, perioperative communication (including "speaking up to power"), and checklists. Monitoring issues involve enforcing existing published monitoring standards and also recognizing the risk of danger to the patient from hypoventilation during procedural sedation and from postoperative intravenous pain medications. Issues of clinical care include medication errors in the operating room, cerebral hypoperfusion (especially in the head-up position), dangers of airway management, postoperative residual weakness from muscle relaxants, operating room fires, and risks specific in obstetric anesthesia.
Recognition of the issues outlined here and empowerment of all anesthesia professionals, from the most senior professors and administrators to the newest practitioners, should help maintain, solidify, and expand the improvements in anesthesia and perioperative patient safety.
本篇简要综述重点从实际情况角度概述围术期患者安全方面当前的一些相关问题。
过去 30 年来，麻醉患者的安全状况得到了显著改善，但这并不是因为电子监护仪的出现，而是主要得益于一系列被称为“安全监测”的行为，这些行为通过电子监测（例如二氧化碳监测和脉搏血氧饱和度监测）扩展了人类的感官，从而变得更加有效。在高度发达的世界中，当前的成功正受到自满和生产压力的威胁。在一些发展中/欠发达国家和地区，挑战在于实施能将安全水平提高到与当前整体成功相媲美的麻醉实践的各个组成部分，例如，应用世界麻醉医师学会联合会（WFSA）“安全麻醉实践国际标准”。一般来说，扩大当前安全方面的成功涉及到许多实际问题。系统问题涉及研究、有效的报告机制和结果分析/传播、围术期沟通（包括“向上级直言不讳”）以及核对清单。监测问题涉及执行现有的发布监测标准，并认识到在程序性镇静期间对患者造成低通气风险以及术后静脉内止痛药物的风险。临床护理问题包括手术室用药错误、脑灌注不足（尤其是头高位）、气道管理的危险、术后肌肉松弛剂残留导致的虚弱、手术室火灾以及产科麻醉的特定风险。
认识到这里概述的问题，并赋予所有麻醉专业人员权力，从最资深的教授和管理人员到最新的从业者，应有助于维持、巩固和扩大麻醉和围术期患者安全方面的改进。
