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psnet.ahrq.gov/node/49539/psn-pdf
June 01, 2007 - Based on preoperative
discussions, the patient expected to receive spinal anesthesia. … The patient reportedly signed an anesthesia
permit required by this hospital that stated that any change … in the anesthesia plan must occur in writing. … For
unclear reasons, the patient ultimately received general anesthesia and suffered the adverse outcome … The anesthesia records failed to
note or explain any change in the anesthesia plan.
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psnet.ahrq.gov/web-mm/when-vomit-gets-way-aspiration-resulting-death-during-endoscopy
March 18, 2020 - Preventing Aspiration Aspiration is a feared complication of anesthesia. … The choice of monitored anesthesia care vs general anesthesia with endotracheal intubation must be carefully … safe as general anesthesia? … Pro-con debate: monitored anesthesia care versus general endotracheal anesthesia for endoscopic retrograde … Rapid sequence induction: its place in modern anesthesia.
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psnet.ahrq.gov/web-mm/pocket-syringe-swap
July 01, 2006 - Surgery proceeded uneventfully under general anesthesia. … of the unique nature of the anesthesia task. … Take-Home Points This case illustrates several points about drug safety in anesthesia: Anesthesia … drug safety in anesthesia. … Preventable anesthesia mishaps: a study of human factors. Anesthesiology. 1978;49:399-406.
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psnet.ahrq.gov/node/35166/psn-pdf
May 26, 2011 - Errors and omissions in anesthesia: a pilot study using a
pilot's checklist. … Errors and omissions in anesthesia: a pilot study using a pilot's checklist. … https://psnet.ahrq.gov/issue/errors-and-omissions-anesthesia-pilot-study-using-pilots-checklist
The … authors tested the efficacy of using a verbal checklist to prepare anesthesiologists to give general
anesthesia … https://psnet.ahrq.gov/issue/errors-and-omissions-anesthesia-pilot-study-using-pilots-checklist
https
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psnet.ahrq.gov/node/37649/psn-pdf
September 27, 2017 - Anesthesia machine as a cause of intraoperative "code
red" in the labor and delivery suite. … Anesthesia machine as a cause of intraoperative "code red" in the labor and delivery
suite. … https://psnet.ahrq.gov/issue/anesthesia-machine-cause-intraoperative-code-red-labor-and-delivery-suite … A case of an intraoperative fire caused by a malfunctioning anesthesia machine is reported in this … https://psnet.ahrq.gov/issue/anesthesia-machine-cause-intraoperative-code-red-labor-and-delivery-suite
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psnet.ahrq.gov/issue/learning-through-simulated-independent-practice-leads-better-future-performance-simulated
June 14, 2019 - This study found that allowing first-year anesthesia residents to independently fail at a scenario, causing … August 4, 2021
An embedded checklist in the Anesthesia Information Management System … November 16, 2015
Simulation in obstetric anesthesia. … January 4, 2012
Management of anesthesia equipment failure: a simulation-based resident
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psnet.ahrq.gov/issue/anesthetic-mishaps-breaking-chain-accident-evolution
April 08, 2011 - A review of anesthesia safety and errors, this article provides an overview of the definitions, issues … April 7, 2019
How does patient safety culture in the operating room and post-anesthesia … December 3, 2014
View More
Related Resources
The Anesthesia Patient … August 22, 2018
Preventing, and managing the impact of, anesthesia awareness. … April 6, 2011
The role of anesthesia in surgical mortality.
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psnet.ahrq.gov/node/40708/psn-pdf
March 02, 2012 - Barriers to adverse event and error reporting in
anesthesia. … Barriers to Adverse Event and Error Reporting in Anesthesia. … Anesthesia & Analgesia. 2011;114(3). doi:10.1213/ane.0b013e31822649e8. … https://psnet.ahrq.gov/issue/barriers-adverse-event-and-error-reporting-anesthesia
This survey found … https://psnet.ahrq.gov/issue/barriers-adverse-event-and-error-reporting-anesthesia
https://psnet.ahrq.gov
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psnet.ahrq.gov/node/47144/psn-pdf
June 13, 2018 - Canadian Anesthesia Incident Reporting System. … https://psnet.ahrq.gov/issue/canadian-anesthesia-incident-reporting-system
Reporting mistakes in anesthesiology … https://psnet.ahrq.gov/issue/canadian-anesthesia-incident-reporting-system
https://psnet.ahrq.gov/issue … /association-between-handover-anesthesia-care-and-adverse-postoperative-outcomes-among
https://psnet.ahrq.gov … impact-comprehensive-safety-initiative-patient-controlled-analgesia-errors
https://psnet.ahrq.gov/issue/influences-observed-incidence-and-reporting-medication-errors-anesthesia
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psnet.ahrq.gov/node/764391/psn-pdf
March 02, 2022 - association-between-handover-anesthesiology-care-and-1-year-mortality-
among-adults-undergoing
Previous research identified a relationship between anesthesia … Analyses revealed that anesthesia handovers were associated
with poorer outcomes (i.e., higher 30-day … -1-year-mortality-among-adults-undergoing
https://psnet.ahrq.gov/issue/association-between-handover-anesthesia-care-and-adverse-postoperative-outcomes-among … psnet.ahrq.gov/primer/handoffs-and-signouts
https://psnet.ahrq.gov/issue/systematic-review-intraoperative-anesthesia-handoffs-and-handoff-tools
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psnet.ahrq.gov/node/38524/psn-pdf
July 13, 2009 - How does patient safety culture in the operating room and
post-anesthesia care unit compare to the rest … How does patient safety culture in the operating room and
post-anesthesia care unit compare to the rest … https://psnet.ahrq.gov/issue/how-does-patient-safety-culture-operating-room-and-post-anesthesia-care- … This study found that operating room (OR) and post-anesthesia care unit
(PACU) staff had a significantly … https://psnet.ahrq.gov/issue/how-does-patient-safety-culture-operating-room-and-post-anesthesia-care-unit-compare-rest
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psnet.ahrq.gov/node/863308/psn-pdf
February 28, 2024 - Monitored anesthesia care (MAC) was selected as the preferred choice for this patient. … The choice of monitored anesthesia care vs general anesthesia with endotracheal intubation must be
carefully … safe as general anesthesia? … Pro-con debate: monitored anesthesia care versus general
endotracheal anesthesia for endoscopic retrograde … Rapid sequence induction: its place in modern anesthesia.
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psnet.ahrq.gov/web-mm/wrong-side-bedside-paravertebral-block-preventing-preventable
August 10, 2019 - The clinical team decided to obtain an anesthesia consultation to place a paravertebral block. … "( 4 ) Wrong-site surgical and anesthesia procedures have been subject to extensive scrutiny. … The environment where paravertebral block and other major regional anesthesia procedures (such as epidural … The environment where major regional anesthesia procedures such as paravertebral blocks are performed … Wrong-site regional anesthesia: review and recommendations for prevention?
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psnet.ahrq.gov/node/44364/psn-pdf
September 07, 2016 - Survey of the national drug shortage effect on anesthesia
and patient safety: a patient perspective. … Survey of the National Drug Shortage Effect on Anesthesia and
Patient Safety: A Patient Perspective. … https://psnet.ahrq.gov/issue/survey-national-drug-shortage-effect-anesthesia-and-patient-safety-patient … https://psnet.ahrq.gov/issue/survey-national-drug-shortage-effect-anesthesia-and-patient-safety-patient-perspective … https://psnet.ahrq.gov/issue/survey-national-drug-shortage-effect-anesthesia-and-patient-safety-patient-perspective
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psnet.ahrq.gov/node/44625/psn-pdf
November 20, 2015 - State-of-the-art usage of simulation in anesthesia: skills
and teamwork. … State-of-the-art usage of simulation in anesthesia: skills and teamwork. … https://psnet.ahrq.gov/issue/state-art-usage-simulation-anesthesia-skills-and-teamwork
Simulation training … This
review discusses simulation training in anesthesia and emphasizes the importance of learning objectives … https://psnet.ahrq.gov/issue/state-art-usage-simulation-anesthesia-skills-and-teamwork
https://psnet.ahrq.gov
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psnet.ahrq.gov/node/37544/psn-pdf
June 16, 2011 - Differences in safety climate among hospital anesthesia
departments and the effect of a realistic simulation-based … Differences in safety climate among hospital anesthesia
departments and the effect of a realistic simulation-based … https://psnet.ahrq.gov/issue/differences-safety-climate-among-hospital-anesthesia-departments-and-effect … In this study, the investigators analyzed safety culture before and after anesthesia staff
underwent … https://psnet.ahrq.gov/issue/differences-safety-climate-among-hospital-anesthesia-departments-and-effect-realistic
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psnet.ahrq.gov/node/47488/psn-pdf
December 21, 2018 - Frequency of medication error in pediatric anesthesia: a
systematic review and meta-analytic estimate … Frequency of medication error in pediatric anesthesia: A
systematic review and meta-analytic estimate … https://psnet.ahrq.gov/issue/frequency-medication-error-pediatric-anesthesia-systematic-review-and-meta … https://psnet.ahrq.gov/issue/frequency-medication-error-pediatric-anesthesia-systematic-review-and-meta-analytic-estimate … https://psnet.ahrq.gov/issue/frequency-medication-error-pediatric-anesthesia-systematic-review-and-meta-analytic-estimate
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psnet.ahrq.gov/node/33932/psn-pdf
May 27, 2011 - Preventable anesthesia mishaps: a study of human
factors. … Preventable anesthesia mishaps: a study of human factors.
Anesthesiology. 1978;49(6):399-406. … https://psnet.ahrq.gov/issue/preventable-anesthesia-mishaps-study-human-factors
This study reports on … incidents at an urban teaching
institution and was a first in using human factors research methods in an anesthesia … https://psnet.ahrq.gov/issue/preventable-anesthesia-mishaps-study-human-factors
https://psnet.ahrq.gov
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psnet.ahrq.gov/node/41423/psn-pdf
January 03, 2017 - Improving documentation of a beta-blocker quality
measure through an anesthesia information management … Improving documentation of a beta-blocker quality measure
through an anesthesia information management … https://psnet.ahrq.gov/issue/improving-documentation-beta-blocker-quality-measure-through-anesthesia- … https://psnet.ahrq.gov/issue/improving-documentation-beta-blocker-quality-measure-through-anesthesia-information … https://psnet.ahrq.gov/issue/improving-documentation-beta-blocker-quality-measure-through-anesthesia-information
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psnet.ahrq.gov/issue/barriers-implementation-checklists-office-based-procedural-setting
February 18, 2019 - October 6, 2021
Office-based anesthesia: safety and outcomes. … August 13, 2014
Administrative issues to ensure safe anesthesia care in the office-based … October 7, 2013
Patient safety and office-based anesthesia. … July 13, 2016
Trends in anesthesia-related liability and lessons learned. … March 6, 2019
Safety in office-based anesthesia: an updated review of the literature