The top anesthesia-related malpractice injury claims are:
- Teeth Damage (21%)
- Death (18%)
- Nerve Damage (13%)
- Organ Damage (13%)
- Pain (11%)
- Cardiopulmonary Arrest (11%)
Average indemnity for an anesthesia claim was $309,066 compared to $291,000 for all physician specialties.
The most frequent claims were death and nerve damage when teeth damage was excluded. Obesity impacted anesthesia outcomes more frequently than did other comorbidities. Although there were fewer claims from the smaller hospitals, those claims had higher rates of mortality and nerve damage compared to larger-size hospitals. Further analysis is needed to evaluate these trends as well as the impact of specific patient comorbidities on anesthesia outcomes.
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The use of Ether to render a patient unconscious for surgery was first administered in the United States in 1846. Over the next 170 plus years, many advances have been made in the field of Anesthesia. New medications and technology have evolved to make anesthesia safer, more comfortable to the patient and more predictable.
Each year, approximately 40 million anesthetics are administered to patients in the United States. Anesthesia, which ranges from the local numbing of the portion of the body where the surgery is to be performed to rendering a patient completely asleep, is an essential part of any surgical procedure.
Anesthesia is administered by medical professionals that include Anesthesiologists (medical doctors) and Certified Registered Nurse Anesthetists (CRNA) in hospital operating rooms, ambulatory surgery centers and physician (and dental) offices.
While modern medicine has made anesthesia generally safe, it is not without significant risk. There are certain anesthesia-related injuries and deaths which are unavoidable. However, many other anesthesia injuries and deaths are completely preventable and directly due to negligence by the anesthesia personnel caring for the patient.
TYPES OF ANESTHESIA
The primary types of anesthesia described below are intended to minimize patient pain during a surgical procedure and, in certain circumstances, eliminate patient memory of a surgical procedure.
Local Anesthesia: This occurs when a small portion or area of the body is rendered numb. For example, local anesthesia is commonly used for dental procedures or when a patient is being sutured. During local anesthesia, the patient remains awake and alert.
Regional Anesthesia: This is used to block pain in an area of the body, such as an arm or a leg. A common example of Regional Anesthesia is an Epidural Anesthesia, which is often used during childbirth to block the mother’s pain from her waist area downward during childbirth. As with Local Anesthesia, the patient remains awake and alert.
MAC Anesthesia/Sedation: This type of anesthesia is often referred to as “twilight anesthesia” or “conscious sedation.” It is administered via an IV line and is intended to make a patient calm and sleepy for a procedure. MAC sedation is often used for out-patient procedures, such as colonoscopies. The level of patient sedation can range from light to heavy. Upon awakening or becoming fully conscious, the patient should have no recollection of the procedure.
General Anesthesia: This type of anesthesia is used to render the patient completely asleep during a surgical procedure.
ANESTHESIA PERSONNEL’S ROLE
The role of the anesthesiologist and the other anesthesia personnel begins well in advance of surgery and continues after its completion. The safe administration of anesthesia requires:
- Identifying specific patient risk for the particular anesthesia to be used.
- Making certain that the patient is properly positioned to reduce the risk of nerve injuries from pressure.
- Repositioning the patient during lengthy operations.
- Administering the proper anesthetic medications at proper dosages to maintain the patient pain-free and comfortable.
- Monitoring the patient’s vital signs to make certain they are within safe and normal ranges throughout the surgery.
- Monitoring the patient’s urine output and blood loss.
The safe administration of anesthesia requires proper communication and teamwork between the anesthesiologist, CRNA, OR nursing personnel and the surgeon.
The anesthesia personnel’s responsibility to the patient continues after the surgery has been concluded. Once the surgery is concluded, the patient is typically transferred to the Recovery Room or the Post-Anesthesia Care Unit (PACU). While in the Recovery Room or the PACU, the anesthesia personnel is responsible for:
- Managing the patient’s emergence from anesthesia.
- Continuously evaluating the patient’s vital signs and oxygen level.
- Making certain that the patient’s post-operative pain level is manageable.
- Evaluating the patient for an intraoperative injury.
- Determining that the patient has regained consciousness and is stable for discharge.
COMMON TYPES OF ANESTHESIA MALPRACTICE
- Improper Dosing
- Administer too high of a dosage can result in delays in emergence from anesthesia, respiratory failure, and even death.
- Administering too low of a dosage or problems with the medication’s delivery can result in Anesthesia Awareness. This occurs when a patient, who is supposed to be unconscious for a surgical procedure, remains awake. Patients with Anesthesia Awareness can hear the surgery being performed and feel pain. However, because they are often given a paralytic medication, the patient is unable to communicate with the medical staff that they are awake. These patients often experience significant and permanent psychologic injuries.
- Anesthesia Monitoring Mistakes
- In certain cases, the dosage of anesthesia administered was appropriate, but the anesthesia personnel failed to monitor the patient’s response to the anesthetic and respond accordingly. With general anesthesia and MAC sedation, the patient is especially vulnerable. This is because the patient’s airway is not protected despite being given potent medications to be maintained comfortable for the procedure. Because each patient responds differently to the medications used to perform MAC sedation, the anesthesia personnel has to be especially alert for changes in the patient’s physiologic response to the anesthesia, such as, decreased breathing, heart rate and blood pressure. If the anesthesia personnel is not vigilant in monitoring the patient’s response to anesthesia and reacting appropriately, a catastrophe can occur.
- Patient Positioning
- It is essential that a patient be properly positioned for surgery. This is especially true for cases performed under general anesthesia or MAC sedation where the patient’s level of consciousness is significantly altered. When this occurs, the patient is unable to change positions or alert the OR staff as to pain. Consequently, the patient is at risk for nerve injury when these types of anesthesia are used. In addition, during lengthy surgical procedures, patient re-positioning is essential to prevent nerve injury.
- Dangerously prolonged sedation.
- Failing to properly intubate a patient for general anesthesia.
- Post-Anesthesia Care
- Because healthcare providers can let down their guard after surgery has been completed, anesthesia-related mistakes often occur in the Recovery Room or PACU. It is essential that the post-operative patient’s vital signs be continuously monitored in the Recovery Room or PACU. As the patient emerges from anesthesia, breathing issues can arise due to the ongoing effect of the anesthesia. If the patient’s breathing slows unbeknownst to the anesthesia personnel, the patient is at risk to stop breathing which can lead to a cardiopulmonary arrest, brain damage and even death.
There is no question that anesthesia, while generally safe and predictable, nonetheless can be extremely dangerous. While injuries from anesthesia mistakes can have devastating consequences, they are a challenge to prove. If you or a loved one has sustained injury (or even worse) from a suspected anesthesia mistake, call us. We have the knowledge and the experience to determine whether you or a loved one’s injury was due to a preventable anesthesia mistake.