A Study of Elderly Spinal Anesthesia Risk Model Development

• Main Authors: Li-Hsing Chen, 陳麗幸
• Other Authors: 張晴翔
• Format: Others
• Language: zh-TW
• Published: 2007
• Online Access: http://ndltd.ncl.edu.tw/handle/14318639331424828298

碩士 === 長榮大學 === 醫務管理學研究所 === 96 === Abstract The aging of population is a focus of global medical care policy. The use of spinal anesthesia in elderly patients has been advocated. In Taiwan, there are 2,312,359 elderly people that occupy 10.09% of the total population. This number is expected to go beyond 21.45% in 2 decades. There appear to be a future trend in the rise of number of elderly patients receiving anesthesia and surgery. Aging increases the risk by 1.42 folds per decade. The multiple risk factors include the influence of aging on drug pharmacokinetics, hemodynamics, physiological status and history of diseases. Although spinal anesthesia and central neuraxial blockade in elderly patients have been advocated, there are still incidences of adverse events or accidents during spinal anesthesia. A review of foreign literature suggests that the incidence rate falls between 7.5-46.8%.In terms of medical errors or types of adverse events, these numbers are a part of active errors, and only present a small component of the system problems. Webster et al suggested that the nuclear power industry is a good analogy for safety in high risk anesthesia practices. Risk management program in anesthesia must be materialized in all aspects of the organization and emphasize the creation of optimum conditions of the “what” and the “how” of anesthesia practice and optimum preparation, in order to minimize the adverse events in anesthesia care. Methods: The clinical assessment and intervention workflow of spinal anesthesia in the elderly, including preparation of anesthesia and risk assessment, and intervention during spinal anesthesia, are proposed by presenting a model of system design. The dependent variables of risk severity of this design were bradycardia and hypotention during elderly spinal anesthesia. Risk assessment and intervention pathway of safety was depicted, and a total of 59 intervention pathways were found. Finally, compare the intervention pathways with records of elderly spinal anesthesia to confirm the approval. SPSS software was applied to perform descriptive analysis, principal components analysis to examine the feasibility of the design, and to find out the principal components. Results: A total of 335 elderly patients were recruited into the study, and 277 patients were found to match the pathway, with a matching rate of 82.7%. After a principal component analysis of all the cases, three principal components appeared that were redefined as: The first component was medication consideration, which included nerve block height, need of operation time and nutrition condition. The second component was elderly physical status consideration, which included aging and ASA status. The third component was preloading of fluid. The three principal component factors could act as references for decision-making of proactive and reactive intervention for anesthetic practice during elderly spinal anesthesia, in order to minimize adverse events and frequency of near miss in anesthesia care, leading to a decrease in accidents, harm, and incidents.