Every Surgery is Risky Business
There is no getting around it - there are inherent risks to surgery. The majority of deoxygenation problems are not caused by treatment error; they are inherent risks of standard treatment tools and techniques and/or the patient's own physiological condition. In fact, a study of nearly 12,000 cardiac surgery patients showed that 75% of strokes occur among the 90% of patients classified as low- to medium-risk pre-operatively1. This demonstrates that current techniques to identify vulnerable patients and methods to protect them from complications have room for improvement. Here are examples of treatment and patient physiology-related risks that can undermine good outcomes:
Treatment-Associated Risks:
- Positioning or shifting of cannulas
- Position of the head or neck
- Clamping of arteries
- Lifting of the heart
- Perfusion rates and methods
- Anesthesia dosage and methods
- Warming and cooling of patients
- Closing the chest incision (most relevant in pediatric surgery)
- Loss of regional blood flow due to blockage or clotting
- ECMO or ventilator treatment
Patient Physiology-Associated Risks:
- Incomplete Circle of Willis
- Level of reactivity to carbon dioxide
- Degree of cerebral autoregulation (i.e., the ability or inability to automatically adjust cerebral blood flow as pressure drops)
- Congenital heart malformations
- Swelling of tissues or accumulation of fluids
Footnote:
1. Likosky et al. Ann Thorac Surg 2003;76:428-35.
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