THE SEVEN SINS OF CLINICAL ANAESTHESIA

— D. JOHN DOYLE MD PhD FRCPC —

Cleveland Clinic Lerner College of Medicine of Case Western Reserve University

John@DanielJohnDoyle.com
1. INCOMPLETE ASSESSMENT
Not obtaining the necessary preoperative information to provide safe anaesthesia. However, in
some emergency situations (e.g. ruptured aortic aneurysm, massive trauma) there may be
insufficient time to perform a complete patient assessment (e.g. medical history, allergies,
previous anaesthetics, etc.). Other potential impediments include language barriers and
patient’s cognitive impairment (e.g. Altzheimer’s disease). Important information in the patient’s
old medical records may be unavailable because files may be destroyed after a time period
(e.g. 10 years), or stored off-site or unavailable only on microfilm during “normal business
hours”. Often old records are unavailable for no obvious reason (“lost”) or available only on 48
hours notice.
2. POOR PREPARATION
Not checking the anaesthesia machine and equipment before starting the case. Proper
preparation for providing an anaesthetic includes:
♦ Anaesthetic machine and monitoring equipment check
♦ Check for suction apparatus
♦ Preparation of airway equipment (e.g. laryngoscope, ETT)
♦ Preparation of syringe of anaesthetic and resuscitation drugs
♦ Preparation of IV equipment
♦ Obtaining specialised items (e.g. heating equipment, cardiac output computer, etc.)
♦ This process can be facilitated by use of a checklist. The specific choices of drugs to
be drawn up and equipment to be made available will of course, depend on clinical
circumstances
3. NOT KNOWING WHAT THE SURGEON IS DOING
Examples include:
♦ Not having an accurate estimate of blood loss
♦ Using halothane when the surgeon is infiltrating the field with epinephrine solution
♦ Not knowing how much local anaesthetic the surgeon has used
♦ Not noticing that the surgeon is pulling the eyeball (causing bradycardia).
4. SLOTH
Examples include:
♦ Not keeping up with charting over time
♦ Incomplete charting (no temperature, no airway pressure)
♦ Not ever measuring patient’s BP manually to validate abnormal BP measurements.
5. PRIDE AND OVERCONFIDENCE
Overconfidence may lead a clinician to inadequately prepare for a case (e.g. not arranging for
a “difficult intubation cart” in a patient who was previously difficult to intubate).
The overly proud clinician may fail for call for needed assistance when needed (e.g. difficult
intubation, massive bleeding, anaphylaxis).
6. DISORGANIZATION
Examples include:
♦ Not labelling IV lines in complex cases
♦ Not labelling syringes
♦ Untidy, disorganized working surface.
7. APATHY
Examples include:
♦ Not identifying and dealing with problems such as faulty equipment, under-stocked
drug charts, etc.
♦ Not attempting to keep current by reading and discussion