Professional Issues and Patient Safety
Safety systems and professional obligations
Consent and standards: informed consent is a process - capacity, disclosure of risks and alternatives, and voluntariness - not a signature on a form. ASA standards require continuous pulse oximetry and capnography for moderate sedation and general anesthesia, with a qualified anesthesia professional immediately available.
Human factors: closed-claims data show respiratory events - inadequate ventilation, esophageal intubation, difficult airway - cause more damage than drug errors, and they cluster at induction, emergence, handoffs, and when supervision is loose.
Medication safety: label every syringe, separate look-alike agents, use barcode scanning where available, and keep lipid emulsion, naloxone, and dantrolene accessible.
Environment: the fire triad is oxidizer, fuel, and ignition. For an airway fire, stop the gas flow, remove the burning tube, and flood the field with saline before reestablishing the airway.
Documentation and conduct: controlled substances require witnessed waste; impaired-provider reporting is mandatory in most jurisdictions; scope-of-practice and supervision ratios follow state law and facility policy.
Traps: the WHO checklist does not replace a formal time-out; assumptions about do-not-resuscitate status in the operating room should be resolved and documented rather than defaulted.
Worked example: a structured handoff (SBAR or I-PASS) covers patient identity, procedure, current anesthetics and infusions, airway findings, and anticipated problems - reducing omission errors at transfer of care.