Patients undergoing a medical procedure or surgery where they need general anesthesia have little to fear from the anesthesia. Amazing strides during the last 25 years has made anesthesia safer. In 1990 deaths related to anesthesia occurred in two patients per 10,000 procedures. Today, that number has fallen to one anesthesia-related death per 200,000 to 300,000 procedures. According to the American Society of Anesthesiologists, “a person is more likely to be struck by lightning than die from anesthesia-related complications. An article on WebMD reports that “not only have errors become relatively uncommon, but experts say that anesthesia is one of the safest areas of health care today.”
Taken together, new drugs, new technology, and a better understanding of how anesthetic agents metabolize, help anesthesiologists accurately figure the right amount of anesthesia for each patient they care for.
In October 2012, the Anesthesia Quality Institute (AQI) became the first organization to collect data about individual problems from anesthesia that are actual occurrences. Dr. Richard Dutton, executive director of AQI and himself an anesthesiologist, say that the program is “an early warning system” when new drugs or anesthesia devices are used in the operating room.
One of the many reasons for improved safety during anesthesia is the use of sophisticated monitoring equipment that warns the anesthesiologist when things are not right. Guidelines for anesthesia best practice from the American Society of Anesthesiologists mandate that audible alarms be used so the anesthesiologist or anesthesia care team members can hear them easily. According to Timothy R. Lubenow, an anesthesiologist at Rush University Medical Center in Chicago new technology is vital in the modern OR. Lubenow said,
“We can monitor and measure vital signs almost on a beat-by-beat basis, and so, are ready to take measures that are necessary to control a problem. Another big advance is the use of nerve blocks before anesthesia to control postoperative pain.”
Another reason that anesthesia is safer, today is the development of new anesthetic agents that work faster and are shorter-acting. Dr. W. Scott Jellish, chairman of anesthesiology at Loyola University Medical Center in Maywood said,
“We have much-shorter-acting inhalation agents today, once turned off, they dissipate very quickly, so wake-up time is much better. And there are now very short-acting narcotics.”
To make sure that safety issues during Monitored Anesthesia Care (MAC) or general anesthesia given in “office settings” are properly addressed, thirty states now require office-based surgery accreditation with more states expected to follow.
Patients Still Fear Anesthesia
Despite all these wonderful advancements, most patients still fear anesthesia as much, or more than surgery itself.
Patient education before administering anesthesia is important. Two of the most important factors that create fear in patients are losing control and the perception that anesthesia has more risks than reality.
One doctor believes that elderly patients are more likely to be in the mindset of dying or having something bad happen to them. She suggests that this is because elderly people recall someone dying or having a bad reaction to anesthesia back in time – 50 or more years ago. On further reflection, this doctor concludes that this same patient most likely knows a contemporary of theirs who died shortly after surgery that happened in the present, or worse, was shipped to a long-term care facility following surgery.
With a short dose of empathy and understanding along with some education these patients go to surgery with their fears allayed. Spend enough time with all your patients before the anesthesia begins to let them you know you understand the fear they may feel trusting others to care for them while unconscious. Doing this is nothing more than great patient care.