Fornebo I, Simonsen K A, Bukholm I R K, Kongsgaard U E
Medical Faculty, Oslo University, Oslo, Norway.
Department of Medical Experts, The Norwegian system of Compensation to Patients (NPE), Oslo, Norway.
Acta Anaesthesiol Scand. 2017 Aug;61(7):781-789. doi: 10.1111/aas.12914. Epub 2017 May 30.
Securing the airway is one of the most important responsibilities in anaesthesia. Injuries related to airway management can occur. Analysis from closed claims can help to identify patterns of injury, risk factors and areas for improvement.
All claims to The Norwegian System of Compensation to Patients from 1 January 2001 to 31 December 2015 within the medical specialty of anaesthesiology were studied. Data were extracted from this database for patients and coded by airway management procedures.
Of 400 claims for injuries related to airway management, 359 were classified as 'non-severe' and 41 as 'severe'. Of the severe cases, 37% of injuries occurred during emergency procedures. Eighty-one claims resulted in compensation, and 319 were rejected. A total of €1,505,344 was paid to the claimants during the period. Claims of dental damage contributed to a numerically important, but financially modest, proportion of claims. More than half of the severe cases were caused by failed intubation or a misplaced endotracheal tube.
Anaesthesia procedures are not without risk, and injuries can occur when securing the airway. The most common injury was dental trauma. Clear patterns of airway management that resulted in injuries are not apparent from our data, but 37% of severe cases were related to emergency procedures which suggest the need for additional vigilance. Guidelines for difficult intubation situations are well established, but adherence to such guidelines varies. Good planning of every general anaesthesia should involve consideration of possible airway problems and assessment of pre-existing poor dentition.
确保气道安全是麻醉中最重要的职责之一。可能会发生与气道管理相关的损伤。对已结案索赔的分析有助于识别损伤模式、风险因素及改进领域。
研究了2001年1月1日至2015年12月31日期间挪威患者赔偿系统中麻醉专业的所有索赔。从该数据库中提取患者数据，并按气道管理程序进行编码。
在400例与气道管理相关的损伤索赔中，359例被归类为“非严重”，41例为“严重”。在严重病例中，37%的损伤发生在急诊手术期间。81例索赔获得赔偿，319例被驳回。在此期间，共向索赔人支付了1,505,344欧元。牙齿损伤索赔在索赔数量上占重要比例，但在经济赔偿方面比例不大。超过一半的严重病例是由插管失败或气管内导管位置不当引起的。
麻醉手术并非没有风险，在确保气道安全时可能会发生损伤。最常见的损伤是牙齿创伤。从我们的数据中，导致损伤的气道管理明确模式并不明显，但37%的严重病例与急诊手术有关，这表明需要额外警惕。困难插管情况的指南已很完善，但对这些指南的遵守情况各不相同。每次全身麻醉的良好规划应包括考虑可能的气道问题和评估术前存在的牙齿状况不佳。
