WebAIRS Articles

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ANZTADC is the Australian and New Zealand Tripartite Anaesthetic Data Committee that created webAIRS, the web-based anaesthetic incident reporting system.

‘WebAIRS’ can be incorporated into hospital systems to assist anaesthetists to report, evaluate and receive information regarding anaesthetic incidents.

Explore current and earlier journal publications relating to WebAIRS below.

Current journal publications

Scroll down to view current and earlier journal publications.

Prevention of arterial oxygen desaturation during anaesthesia with high-flow nasal oxygen (HFNO) has gained greater acceptance for a widening range of procedures. However, during HFNO use there remains the potential for development of significant anaesthesia-associated apnoea or hypoventilation and the possibility of hypercarbia, with harmful cardiovascular or neurological sequelae. The aim of this study was to determine whether any HFNO-related hypercarbia adverse incidents had been reported on webAIRS, an online database of adverse anaesthesia-related incidents. Two relevant reports were identified of complications due to marked hypercarbia during HFNO use to maintain oxygenation. In both reports, HFNO and total intravenous anaesthesia were used during endoscopic procedures through the upper airway. In both, the extent of hypoventilation went undetected during HFNO use. An ensuing cardiac arrest was reported in one report, ascribed to acute hypercarbia-induced exacerbation of the patient’s pre-existing pulmonary hypertension. In the other report, hypercarbia led to a prolonged duration of decreased level of consciousness post procedure, requiring ventilatory support. During the search, an additional 11 reports of postoperative hypercarbia-associated sedation were identified, unrelated to HFNO. In these additional reports an extended duration of severe acute hypercarbia led to sedation or loss of consciousness, consistent with the known effects of hypercarbia on consciousness. These 13 reports highlight the potential dangers of unrecognised and untreated hypercarbia, even if adequate oxygenation is maintained.
 
Pattullo GG, Culwick MD, Endlich Y, MacPherson RD. Hypercarbia and high-flow nasal oxygen use during anaesthesia – risking a failure to thrive?. Anaesth Intensive Care. 2023;51(6):400-407.

Personal experience may be the best teacher, and learning from clinical incidents in one’s own practice very likely has a greater impact on future behaviour than hearing or reading about the experience of others. Yet relying on personal experience would be a very slow process to cover the wide range of potential clinical incidents that could occur. Our aim as anaesthetists is to avoid clinical incidents wherever possible, whether they involve harm, fortuitous no harm, or a crisis. To this end we benefit by hearing about clinical incidents experienced by our colleagues. 

In this issue of Anaesthesia and Intensive Care, there are four papers reporting data obtained from the webAIRS database of voluntary de-identified on-line reports of clinical incidents in Australia and New Zealand. 

Gibbs NM. Clinical incident reporting: Extending the learning opportunities through webAIRS. Anaesth Intensive Care. 2023 Nov;51(6):372-374.

There were 684 perioperative cardiac arrests reported to webAIRS between September 2009 and March 2022. The majority involved patients older than 60 years, classified as American Society of Anesthesiologists Physical Status 3 to 5, undergoing an emergency or major procedure. The most common precipitants included airway events, cardiovascular events, massive blood loss. medication issues, and sepsis. The highest mortality rate was 54% of the 46 cases in the miscellaneous category (this included 34 cases of severe sepsis, which had a mortality of 65%). This was followed by cardiovascular precipitants (n = 424) in which there were 147 deaths (35% mortality): these precipitants included blood loss (53%), embolism (61%) and myocardial infarction (70%). Airway and breathing events accounted for 25% and anaphylaxis 8%.

Bright MR, Endlich Y, King ZD, White LD, Concha Blamey SI, Culwick MD. Adult perioperative cardiac arrest: An overview of 684 cases reported to webAIRS. Anaesth Intensive Care. 2023 Nov;51(6):375-390. 

Regional anaesthesia is an essential tool in the armamentarium for paediatric anaesthesia. While largely safe and effective, a range of serious yet preventable adverse events can occur. Incidence and risk factors have been described, but few detailed case series exist relating to paediatric regional anaesthesia. Paediatric perioperative events and their outcomes were reviewed from the regional anaesthesia reports among the first 8000 reports to the webAIRS database. Please click the link below to read the full article in the journal Anaesthesia and Intensive Care 2023.

Mistry MM, Endlich Y. Incidents relating to paediatric regional anaesthesia in the first 8000 cases reported to webAIRS. Anaesth Intensive Care. 2023 Nov;51(6):408-421.

Anaesthesia for caesarean section occurs commonly and places specific demands on anaesthetists. We analysed 469 narratives concerning anaesthesia for caesarean section, entered by Australian and New Zealand anaesthetists into the webAIRS incident reporting system between 2009 and 2022. To read the full article click in the link below.

Eley VA, Culwick MD, Dennis AT. Analysis of anaesthesia incidents during caesarean section reported to webAIRS between 2009 and 2022. Anaesth Intensive Care. 2023 Nov;51(6):391-399.

Corneal abrasions are an uncommon complication of anaesthesia. The aim of this study was to identify potential risk factors, treatment and outcomes associated with corneal abrasions reported to the web-based anaesthesia incident reporting system (webAIRS), a voluntary de-identified anaesthesia incident reporting system in Australia and New Zealand, from 2009 to 2021. There were 43 such cases of corneal abrasions reported to webAIRS over this period. The most common postoperative finding was a painful eye. Common features included older patients, individuals with pre-existing eye conditions, general anaesthesia and procedures longer than 60 minutes. Most cases were treated with a combination of lubricating eye drops or aqueous antibiotic eye drops. The findings indicate that patients who sustain a perioperative corneal abrasion can be reassured that in many cases it will heal within 48 hours, but they should seek earlier review if symptoms persist or deteriorate. None of the cases in this series resulted in permanent harm. Well established eye protective measures are important to utilise throughout the perioperative period, including the time until the patient has recovered in the post-anaesthesia care unit.

Bright MR, White LD, Concha Blamey SI, Endlich Y, Culwick MD. Perioperative corneal abrasions: A report of 42 cases from the webAIRS database. Anaesth Intensive Care. 2023 Jan;51(1):63-71. 

Medication error is a well-recognised cause of harm to patients undergoing anaesthesia. From the first 4,000 reports in the webAIRS anaesthetic incident reporting system, we identified 462 reports of medication errors. These reports were reviewed iteratively by several reviewers paying particular attention to their narratives. The commonest error category was incorrect dose (29.4%), followed by substitution (28.1%), incorrect route (7.6%), omission (6.5%), inappropriate choice (5.8%), repetition (5.4%), insertion (4.1%), wrong timing (3.5%), wrong patient (1.5%), wrong side (1.5%), and others (6.5%). Most (58.9%) of the errors resulted in at least some harm (20.8% mild, 31.0% moderate and 7.1% severe). Contributing factors to the medication errors included the presence of look-alike medications, storage of medications in the incorrect compartment, inadequate labelling of medications, pressure of time, anaesthetist fatigue, unfamiliarity with the medication, distraction, involvement of multiple people, and poor communication. These data add to current evidence suggesting a persistent and concerning failure to effectively address medication safety in anaesthesia. The wide variation in the nature of the errors and contributing factors underline the need for increased systematic and multifaceted efforts underpinned by a strengthening of the current focus on safety culture to improve medication safety in anaesthesia. This will require the concerted and committed engagement of all concerned, from practitioners at the clinical workface, to those who fund and manage healthcare.

Kim JY, Moore MR, Culwick MD, Hannam JA, Webster CS, Merry AF. Analysis of medication errors during anaesthesia in the first 4000 incidents reported to webAIRS. Anaesth Intensive Care. 2022 May;50(3):204-219.

Earlier journal publications