Abstract
Anaesthetists’ Society, Calgary, Alberta. The Critical Incident Technique was used to study anaesthetics given in a major tertiary care teaching hospital in order to define indications for monitoring with a pulse oximeter during anaesthesia. Anaesthetists were asked to use a pulse oximeter in every case and trained to report Critical incidents in order to determine if the oximeter can shorten the time to detection of these events. Four thousand seven hundred and ninety-seven anaesthetics were given during a four-month period in 1986-87. A Critical Incident was recorded when an unexpected physiologic deterioration requiring intervention by the anaesthetist to prevent a likely bad outcome was signalled first by the pulse oximeter. Critical Incidents were classified by patient characteristics, physiologic change, type of anaesthetic, and the type, length, and place of surgery. Reports were received in 65 per cent of cases, and a Critical Incident occurred in 191 (six per cent) of these. Desaturation was the commonest physiologic change (151) and was further classified as to severity (mild 85 -94 per cent saturation, moderate 75-84 percent, and severe 75 per cent). Desaturations during the maintenance phase of anaesthesia were milder but more frequent than those in the induction or emergence phases. There were no severe desaturations in elderly patients or those receiving regional anaesthesia. No group was free of Critical Incidents. Since undetected hypoxaemia may lead to disastrous complications we recommend that a pulse oximeter be used for every anaesthetic.
Résumé
La technique des incidents critiques (Critical incident Technique) était utilisée afin ďétudier les agents anesthésiques administrés dans un centre hospitalier tertiaire ďenseignement afin de définir les indications ďune surveillance avec un saturomètre (pulse oximeter) durant ľanesthésie. Les ânesthésiologistes devaient utiliser le saturomètre dans chaque cas et devaient être entraênés à rapporter les incidents critiques afin de déterminer si ľoxymètre pouvait diminuer le temps de détection de ces incidents. 4797anesthésiesfurent administrées durant quatre mois en 1986-87. Un incident critique est enregistré aussitôt quand on détectait avec le saturomètre une détérioration phvsiologique subite requérant ľintervention de V anesthésiologiste pour prévenir la possibilité ďune complication. Les incidents critiques étaient classifies ďaprès les caractéristiques du patient, les changements physiologiques, le type ďanesthésie et le type, la durée, et place de la chirurgie. Les rapports ont été reçus dans 65 pour cent des cas et un incident critique est survenu dans 191 (sixpour cent) de ceux-ci. La désaturation était le changement physiologique le plus commun (151) et elle fut de plus classifiée selon sa sévérité (légère 85 à 94 pour cent saturation, modérée 75-84 pour cent, et sévère <75 pour cent). Les désaturations durant la phase de maintien de ľanesthésie étaient légères mais plus fréquentes que celles qui sont survenues lors de ľinduction ou de la phase de ľémergence. On a noté aucune désaturation sévère chez les patients âgés et chez ceux subissant une anesthésie régionale. Aucun groupe n’était libre ďincident critique. Etant donné que ľhypoxémie non détectée peut aboutir à des complications désastreuses on recommande que le saturomètre soit utilisé avec chaque administration de ľanesthésie.
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McKay, W.P.S., Noble, W.H. Critical incidents detected by pulse oximetry during anaesthesia. Can J Anaesth 35, 265–269 (1988). https://doi.org/10.1007/BF03010621
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DOI: https://doi.org/10.1007/BF03010621