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Prevention of injuries in the anaesthetised patient

  • General anesthesia removes many of the bodies natural protective mechanisms
  • Iatrogenic injury is therefore possible
  • Many of these injuries can produce lasting disability
  • Can also lead to litigation
  • Recognition of risks and prevention is essential

Injuries in the anaesthetised patient

  • Nerve injuries
    • Brachial plexus
    • Ulnar nerve
    • Radial nerve
    • Common peroneal nerve
  • Tissue injuries
    • Corneal abrasions
    • Teeth or crowns
    • Diathermy burns
    • Dislocations or fractures
  • Anaesthetic
    • Drug reactions
    • Hypoxia
    • Awareness

Nerve injuries

  • The incidence of nerve injuries is unknown
  • In USA account for 15% of postoperative litigation claims
  • Most are due to careless positioning of the patient
  • Commonest nerves affected are ulnar and common peroneal nerves and brachial plexus
  • Predisposing factors include:
    • Medical conditions associated with a neuropathy (e.g. diabetes mellitus)
    • Nerve ischaemia due to hypotension
    • Local injections or direct nerve injury
    • The use of a tourniquets
  • Most are due to a neurapraxia
  • 90% undergo complete recovery
  • 10% are left with residual weakness or sensory loss

Ulnar nerve

  • Caused by arms along side patient in pronation
  • Ulnar nerve compressed at elbow between table and medial epicondyle
  • Prevented by positioning arms in supination

Brachial plexus

  • Caused by excessive arm abduction or external rotation
  • Prevented by avoiding more than 60° abduction if possible
  • Should avoid arm falling off side of table

Common peroneal nerve

  • Caused by direct pressure on the nerve with legs in lithotomy position
  • Nerve compressed against neck of fibula
  • Prevented by adequate padding of lithotomy poles

Radial nerve

  • Caused by tourniquet or misplaced injection in deltoid muscle
  • Prevented by adequate padding of tourniquets

Bibliography

Ogbue M N,  Jefferson P,  Ball D R.  Perioperative peripheral nerve injury.  Anaesthesia 2001;  56:  393-394.

Prielipp R C,  Morell R C,  Butterworth J.  Ulnar nerve injury and perioperative arm positioning.  Anesthesiol Clin North Am 2002; 20:  351-365.

 

 
 

Last updated: 05 January 2008

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