M and M Questions

Minimising Anaesthesia Related Mortality and Morbidity

 

The following questions are based on case reports from a wide variety of sources.

They are intended to remind anaesthetists of hazards and  to consider how they would reduce the risks of these events occurring. Or of to manage them optimally should they occur.

Answers may range from one word to several pages.

(AnaesthesiaCases plans to publish sample answers in the near future).

Comments, sample answers and further scenarios for inclusion are invited.

Simply click the “add a comment” button at the bottom of the page, or click on the Comments box on the home page.

 

 

#1   How can you reduce the possibility of your patient having undiagnosed oesophageal intubation?

 

#2   How can you ensure that throat packs  are removed at the end of a case?

 

#3   What audible alarms should be set on all GA’s?

 

#4   Should the pulse oximeter tone signal always be audible?

 

#5   What is an acceptable level of blood pressure intra-operatively?

 

#6   Which patients require airway protection for gastroscopy?

 

#7   How do you avoid spinal cord (conus) damage with spinal anaesthesia?

 

#8   What do you do if you are unable to intubate a patient?

 

#9   How do you ventilate a patient with severe asthma?

 

#10  How do you reduce the likelihood of premature extubation?

 

#11  What is your initial management of aspiration in the OT?

 

#12  How can the effects of IPPV on the circulation in shocked patients be minimized?                                                                     

 

#13  How can you reduce the chance of alcoholic skin prep catching alight?

 

#14  How can the incidence of syringe swap be reduced?

 

#15  How can the incidence of LA toxicity be reduced?

 

#16  At what stage of an anaesthetic should you call for help when difficulties arise?

 

#17  How would you manage a case of a blocked airway filter?

 

#18  How do you manage the detrimental effects of bone cement on the circulation?

 

#19  What are the hazards of large mediastinal masses in anaesthesia?

 

#20  Which IV lines should be flushed before patients leave the OT?

 

#21  What post-op monitoring do patients with PCA’s require?

 

#22  How can wrong side blocks and operations be prevented?

 

#23  What is fixation error?

 

#24  Is it reasonable to use rocuronium in elderly patients?

 

#25  What should you do if you have a serious adverse outcome following an anaesthetic?

 

#26  What are the signs of an anaphylactic reaction?

 

#27  What are the hazards of anaesthesia for shoulder surgery in the beach chair position?

 

#28  How do you maintain vigilance in your care of anaesthetized patients?

 

#29  How can you ensure that tourniquets are deflated after use?

 

#30  How can epidural anaesthesia cause maternal cardiac arrest in labour ward?

 

#31  What can cause life-threatening  hyponatraemia in otherwise healthy patients post-operatively?

 

#32  How can the risks of epidural haematoma be minimised?

 

#33  How can the incidence of aspiration be reduced?

 

#34  What are the principles for managing epiglottitis?

 

#35  How can you reduce the likelihood of leaving the vapouriser on too high a setting?

 

#36  How do you monitor your patient after spinal anaesthesia?

 

#37  How should patients with OSA be monitored post-operatively?

 

#38  What causes airway fires?

 

#39  How do you assess adequacy of spinal block for Caesarean Section?

 

#40  How do you assess a patient bleeding post-partum?