Anaesthesiology
Patient Safety in Anaesthesia
Patient safety in anaesthesia for MBBS and NEET-PG: positioning nerve injuries, perioperative hazards, awareness, SBAR communication and medication errors, mapped to NMC codes AS10.
MedNext Academy | 3 min read
Patient Safety in Anaesthesia
Patient safety in anaesthesia for MBBS and NEET-PG: positioning nerve injuries, perioperative hazards, awareness, SBAR communication and medication errors, mapped to NMC codes AS10.
This chapter covers the systems and behaviours that keep anaesthetised patients safe, from the hazards of positioning to the prevention of perioperative complications and medication errors. It emphasises structured communication, human factors and a just culture of incident reporting.
High-yield: Patient Safety in Anaesthesia
- Incorrect patient positioning can cause nerve injury, pressure sores, ocular injury and cardiovascular and respiratory compromise.
- The common peroneal nerve is the most commonly injured nerve in the lithotomy position, from pressure at the neck of the fibula.
- The ulnar nerve is the most commonly injured nerve overall in anaesthesia, from pressure at the elbow in the supine patient.
- Excessive abduction of the arm beyond 90 degrees risks a stretch injury to the brachial plexus.
- Post-operative visual loss from ischaemic optic neuropathy is a rare but devastating complication of prolonged prone surgery.
- The steep head-down (Trendelenburg) position raises intracranial and intraocular pressure and can worsen ventilation.
- Perioperative hazards include hypoxia, aspiration, awareness under anaesthesia, hypothermia, deep vein thrombosis and drug errors.
- Awareness under anaesthesia is more likely with total intravenous techniques, muscle relaxants and haemodynamically unstable patients, and depth-of-anaesthesia monitoring can reduce it.
- Structured communication tools such as SBAR (situation, background, assessment, recommendation) reduce error at handover.
- Closed-loop communication, where an instruction is read back and confirmed, prevents misheard drug and dose orders.
- Medication errors in anaesthesia are reduced by colour-coded and clearly labelled syringes, a standard layout and reading the ampoule label aloud.
- Look-alike and sound-alike drugs, such as adrenaline and ephedrine or heparin ampoules of different strengths, are a recognised source of error.
- A just culture and open, non-punitive incident reporting improve safety more than blaming the individual involved.
- Human factors such as fatigue, distraction, poor lighting and production pressure contribute to many anaesthetic errors.
Positioning nerve injuries
- **Ulnar nerve:** Most common nerve injury overall. Pressure at the elbow in the supine patient.
- **Common peroneal nerve:** Most common injury in lithotomy. Pressure at the fibular neck.
- **Brachial plexus:** Stretch injury from arm abduction beyond 90 degrees.
- **Ischaemic optic neuropathy:** Rare visual loss after prolonged prone surgery.
NMC competencies in this chapter
- **AS10.1:** Hazards of incorrect patient positioning
- **AS10.2:** Perioperative hazards and their prevention
- **AS10.3:** The role of communication in patient safety
- **AS10.4:** Medical and medication errors in anaesthesia
Frequently Asked Questions
Which nerves are most often injured by positioning?
The ulnar nerve at the elbow is the most commonly injured nerve overall in anaesthesia, and the common peroneal nerve at the fibular neck is the most commonly injured in the lithotomy position.
What is awareness under anaesthesia?
It is the patient becoming conscious and later recalling events during general anaesthesia. It is more likely with intravenous techniques, muscle relaxants and instability, and depth-of-anaesthesia monitoring can reduce it.
How does communication improve patient safety?
Structured tools such as SBAR standardise handover, and closed-loop communication, where orders are read back and confirmed, prevents misheard drug and dose instructions from reaching the patient.
How are medication errors reduced in anaesthesia?
By colour-coded and clearly labelled syringes, a standard drug layout, reading the ampoule label aloud, and being alert to look-alike and sound-alike drugs, supported by open incident reporting.
Continue reading
MBBSAll Anaesthesiology chapters
Continue through the Anaesthesiology chapter map.
Continue studying Anaesthesiology
Explore clinician-written learning resources, structured revision and practice across the MedNext platform.
Open in the MedNext appSee plans