A Case of a Power Failure in the Operating Room

Abstract

In the operating room, safely administering anesthesia amidst a major power failure can instantly present one with a formidable challenge. A case is presented involving a 23-year-old healthy woman who underwent a complex oral and maxillofacial surgery to correct a dentofacial deformity. Three hours into the case and with the patient's maxilla downfractured, the overhead surgical lights blacked out, and there was an apparent loss of the anesthesia machine's ability to function. Providing adequate oxygenation, ventilation, anesthesia levels, monitoring of vital signs, and transportation of the patient were some of the challenges faced, and the response to this unexpected event is recounted. The importance of one's familiarity with an anesthesia machine's backup battery supply, routinely checking machinery, ensuring that appropriate and sufficient supplies are readily available, exercising calm leadership with clear communication, and formulating a clear plan with backup alternatives are discussed. Various recommendations are proposed with respect to the preparation for and the prevention of a power failure in the operating room. This report's account of events is aimed to ''shed some light'' on this topic, serve as a check of one's own preparedness, and facilitate the optimal management of a similarly unexpected incident.

Health care during electricity failure: The hidden costs

“…A utility grid with back-up diesel generator is the most common electricity system in healthcare facilities [ 46 , 47 ], including in the United States. In fact, during the 2003 Northeast blackout [ 30 , 48 , 49 ], Hurricanes Katrina, Sandy, and Maria [ 41 , 50 – 52 ], medical disruptions and patient deaths, associated to electric grid failure, were recorded, especially where all the hospital diesel generators failed. One particular US anesthesiologist laments that with all of his medical training, his medical training proved insufficient mid-surgery when he was constantly told to finish up because the batteries were depleting charge and not knowing what to do if they fail.…”

“…With this information, a medical professional can change these values and calculate the risk, affording them the information to make medical decisions based on electrical data. Decisions can, and should be, made with models when data does not exist [ 30 ]. This means creating a EHS-Risk Chart for ease of understanding the medical consequences to decisions.…”

“…[ 27 ] Without any data or quantifiable models on which to base medical decisions, it is difficult to evaluate alternatives or solutions. Although there is a lack of data, there exists a gamut of anecdotal experiences [ 6 , 23 , 29 , 30 ] from experts on such ethical dilemmas [ 19 ].…”

Modeling Hospitals’ Adaptive Capacity during a Loss of Infrastructure Services

“…Nates discusses the details of adaptation and response to the same storm within a critical care unit of Memorial Hermann Hospital [17]. Yasny and Soffer describe a case study in adaptation within an operating room when power failed during complex surgery; they also offer recommendations for preparations to deal with such events [18]. Several accounts of the chaotic conditions and individual and organizational adaptations used in healthcare facilities during Hurricanes Katrina and Rita in 2005 have been given, including Dosa et al, Gray and Hebert, Klein and Nagel, and Bernard and Mathews [19][20][21][22].…”

Creating a Cognitive Aid for Use During Intraoperative Power Failures

“…Operating room crises are low‐incidence high‐risk events that are stressful and require rapid and coordinated patient care under crucial time restraints 8‐10 . Similar to other OR crises (eg, malignant hyperthermia, refractory hypoxemia, cardiac arrest), an IOPF can be detrimental to a patient if it is not effectively managed 2‐6,8,11‐13 …”