basing reaction on outcome severity vs risk probability

Studies were also conducted during the same period in France by Tiret et al. The direct result of this study in Australian anesthesia practice was the phasing out of the resident medical officer as an anesthesia work force member. The three most common causes of death in their report were inadequate preparation of the patient and inadequate intraoperative and postoperative crisis management. The mortality rate decreased from 1 in 5,500 in the 1960s to 1 in 10,250 in the 1970s and to 1 in 26,000 in 1984. Holland 11 from New South Wales, Australia, between 19 reported on deaths occurring within 24 hours of an anesthetic. They attributed this positive change to improvements in routine monitoring, better supervision of trainees, a decrease in caseload per anesthesiologist, and the introduction of recovery rooms and ICUs during their study period. Harrison 10 noted that anesthesia-related deaths had significantly decreased in the later stages of their study as compared with the data gathered during the initial phases. reported that anesthesia-related mortality was highest in patients older than 65 years and anesthesia contributed to 2.2% of perioperative mortality. 8, 9 from Wales and Harrison 10 from South Africa independently evaluated mortality associated with surgery in the 1970s and 1980s. Six months after the surgery, the visual acuity in the left eye had improved to 20/25, with a persistent left temporal field deficit.įarrow et al. The patient was discharged on postoperative day 45 with some residual upper extremity weakness and improving visual acuity. The patient’s hospital course was further complicated by a chest infection that necessitated antibiotic treatment and noninvasive ventilation. On the second postoperative day, he suffered an acute anterior wall myocardial infarction (MI) caused by stent thrombosis, along with transient blindness in the right eye, which quickly resolved. He complained of reduced vision in his left eye along with weakness and reduced sensation in his upper right arm on the first postoperative day, and was diagnosed with posterior ischemic optic neuropathy and brachial plexopathy. His trachea was successfully extubated the next morning. He was transferred to an intensive care unit (ICU) for postoperative care after the procedure. The patient experienced brief periods of hypotension during the procedure, which responded to fluid therapy and intermittent boluses of ephedrine.

The surgery lasted 8 hours, and four units of packed red blood cells were transfused intraoperatively. Aspirin was continued perioperatively but clopidogrel was discontinued. Thereafter, he began to experience symptoms of spinal cord compression, and surgery was urgently performed 6 weeks after the angioplasty. After an angiogram showed 80% stenosis in the LAD artery, he underwent an uneventful coronary angioplasty with placement of a bare metal stent in the LAD. As part of the preoperative workup, the patient had a stress thallium study, which was positive for inducible ischemia in the area of the left anterior descending (LAD) artery. A 50-year-old, morbidly obese, male patient with renal insufficiency, a history of transient blindness in the right eye, and chronic stable angina class II was scheduled to undergo an elective lumbar vertebrectomy (L1-4) and posterior spine stabilization.

Basing reaction on outcome severity vs risk probability