Haydarpasa Numune Med J. 2016; 56(3): 186-190

Adverse Outcomes During Management Evaluated By Council of Forensic Medicine

Habib Bostan¹, Ayþegül Ertan², Hüseyin Öz³, Ziya Salihoðlu^4
1The Ministry of Justice, Council of Forensic Medicine, Istanbul, Turkey
²Department of Anesthesiology, Istanbul Medipol University Faculty of Medicine, Ýstanbul,Turkey
³Department of Anesthesiology, Bezmialem Vakif University Faculty of Medicine, Ýstanbul,Turkey
⁴Department of Anesthesiology, Dokuz Eylül University Faculty of Medicine, Ýzmir, Turkey

INTRODUCTION: Unsuccessful airway management at anesthesia practice can result with death or permanent brain damage. In this study we investigate the cases which are in dispute by the accusation of problematic airway control during anesthesia and that sent to Council of Forensic Medicine for expertise by court.
METHODS: We retrospectively analyzed 37 case files between the years of 2006-2012 which were in dispute by the accusation of problematic airway control during anesthesia and that were evaluated by Council of Forensic Medicine.
RESULTS: 27 (72.98%) of the cases were female, 10 (27.02%) of the cases were male. The distrubution of cases were as follows: 16 of cases (43.23%) were from Obstetrics and Gynecology, 7 of cases (18.91%) were from ENT, 6 of cases (16.21%) were from general surgery. The airway management in 27 cases (72.97%) were planned intervention, and 10 of the cases (27.03%) were urgent. While the preoperative preparations in 20 cases were adequately completed, the preparations in 17 cases were inadequtely completed. The number of cases that the anesthesia was performed by anesthesiologist or by anesthesia technicians with anesthesiologist supervision seems to higher than the cases that the anesthesia was performed by anesthesia technicians with surgeon supervision. It was found that most frequent adverse outcome was the difficult intubation with difficult ventilation (37.83%). Tracheal injuries ( 18.91 %) and esophageal injuries ( 10.81 %) followed this respectively. Patients who underwent tracheostomy because of difficult intubation was 16.21% of all cases.
DISCUSSION AND CONCLUSION: It is necessary to be prepared for difficult airway possibility even if difficult intubation criteria aren’t detected. We suggest that training program on the recognization and management of difficult intubation and must be generalized. We predict that, with this generalized training program, the adverse outcomes and lawsuits might decrease.

Keywords: Airway management, malpractice, forensic medicine, general Anesthesia

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Adli Týp Kurumu'nda Deðerlendirilen Havayolu Yönetimi Sýrasýnda Ortaya Çýkan Ýstenmeyen Durumlar

Habib Bostan¹, Ayþegül Ertan², Hüseyin Öz³, Ziya Salihoðlu^4
1Adalet Bakanlýðý, Adli Týp Kurumu, Ýstanbul
²Ýstanbul Medipol Üniversitesi Týp Fakültesi, Anesteziyoloji Anabilim Dalý, Ýstanbul
³Bezmialem Vakýf Üniversitesi Týp Fakültesi, Anesteziyoloji Anabilim Dalý, Ýstanbul
⁴Dokuz Eylül Üniversitesi Týp Fakültesi, Anesteziyoloji Anabilim Dalý, Ýzmir

GÝRÝÞ ve AMAÇ: Ülkemizde, genel anestezi uygulamalarý esnasýnda oluþan hava yolu yönetimi ile ilgili sorunlarý adli yönden inceleyen bir çalýþma bulunmamaktadýr. Bu çalýþmada hava yolu yönrtimi sýrasýnda istenmeyen durumlarýn yaþandýðý iddiasý ile dava konusu olan ve bilirkiþi incelemesi için Adli Týp Kurumu’na gönderilen olgular incelenmiþtir.
YÖNTEM ve GEREÇLER: Adli Týp Kurumu’nda 2006-2012 yýllarýna ait hava yolu yönrtimi sýrasýnda istenmeyen durumlarýn yaþandýðý iddiasý ile dava konusu olan ve görüþ bildirilen 37 dosya retrospektif olarak incelendi.
BULGULAR: Olgularýn 27’si (% 72.98) kadýn, 10’u (% 27.02) erkekti. Klinik branþlara daðýlýmý incelendiðinde; 16 olgu Kadýn Hastalýklarý ve Doðum (% 43.23), 7 olgu Kulak Burun Bogaz (%18.91), 6 olgu Genel Cerrahi (%16.21) ’yi ilgilendiriyordu. Olgularýn 27’sinde (% 72.97) müdahale planlý, 10’unda (% 27.03) acil idi. Olgularýn 20’sinde preoperatif hazýrlýðýn tam olarak yapýldýðý, 17 olguda da bu hazýrlýkta eksiklikler olduðu saptandý. Anestezi uzmaný veya anestezi uzmaný ile birlikte anestezi teknisyeninin anestezi uyguladýðý olgularýn (% 75,67) oranýnýn cerrahýn kontrolünde anestezi uygulayan anestezi teknisyeninkilere göre daha fazla olduðu görülmektedir. Zor entübasyon ile birlikte zor ventilasyon (% 37.83) en sýk karþýlaþýlan istenmeyen durum olarak bulundu. Bunu trakeal yaralanmalar (% 18.91) ve özefagus yaralanmalarý (% 10.81) takip etti. Zor entübasyon nedeniyle entübe edilemeyen ve trakeostomi açýlan olgular tüm olgularýn %16.21’ ini oluþturmaktadýr.
TARTIÞMA ve SONUÇ: Zor entübasyon kriterleri saptanmasa bile zor hava yolu geliþme riski göz önünde bulundurularak gerekli hazýrlýklar yapýlmalýdýr. Ayrýca zor havayolunun tanýnmasý ve yönetilmesine yönelik eðitimin yaygýnlaþtýrýlmasý gerektiðini düþünüyoruz.

Anahtar Kelimeler: Havayolu yönetimi, malpraktis, adli týp

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