Anesthesia Injury
Claims arising from anesthesia mistakes are devastating, often resulting in permanent injury, profound brain damage or death. Most anesthesia injuries occur in the operating room, however, they can occur in a wide variety of settings, including the pre-operative and post-operative recovery rooms, during labor and delivery, during sedation for pain management procedures, and during a wide variety of out-patient medical procedures in surgical clinics and doctor’s offices.
Anesthesia malpractice claims are not limited to anesthesiologists. Anesthesia related injuries to patients can be reduced with proper specialty training and certification. Catastrophic complications and death may occur in dental offices and in the cosmetic surgery clinics during procedures under general anesthesia, where trained anesthesia staff is absent. Potential defendants in anesthesia related malpractice matters include anesthesiologists, nurses, nurse anesthetists, fellows and residents in training, surgeons, other doctors, and dentists.
Anesthesia care begins with an interview and examination of the patient prior to the procedure. It is often done days before surgery. Taking an accurate history is equally as important as performing a thorough examination. A proper history included obtaining a list of current medications, allergies, and previous surgical experiences, and to determine if there have been other anesthesia complications.
The anesthesia staff has a duty to obtain informed consent from the patient. The physician has a duty to inform the patient of material risks. This does not require the physician to inform the patient of every risk, but should include the most common risks, even if they are not serious, and the most serious risks, even if they are not common.
The pre-anesthesia records typically record the operative plans and contain check lists for pre-operative data and patient assessment. Most importantly, the records contain the identity of all of the participants in the procedure. Final assessment of the patient for tolerance of the procedure should take place at this point.
The anesthesia staff is responsible for the positioning of the patient, placement of intravenous lines, and set-up of monitoring equipment, including electrocardiograms to monitor heart function and pulse oximetry to monitor oxygen saturation of the blood. Blood pressure is monitored by automatic pressure cuffs. The anesthesia staff is also responsible for the intubation and placement of airways, the positioning of the patient, placement of tourniquets, and the administration and delivery of agents (sedatives and anesthetics), medicines, intravenous fluids, and oxygen. The staff is also responsible for monitoring and evaluating fluid inputs and outputs, including urine output and blood loss.
Data for all of these functions is often recorded into a single graphical chart. The chart contains entries at regular intervals for vital signs, fluids, agents and drugs. There are also checklists, numerous data blocks, and notes for key events which correspond to the time sequence. Even in modern settings there should be an original hand-written anesthesia record, and it must be inspected in detail for clues about complications. The patient should not be discharged from the operating room to the recovery room unless she is stable, and that should be recorded in the notes.
The patient in the post-anesthesia care unit (PACU) is in the service of the anesthesia department. Nurses and other staff from that department are required to continue to monitor, at regular intervals, vital signs and pulse oximetry, and to assess the patient’s readiness for discharge from the unit, either to another hospital service, or from the hospital. In the PACU, it is the duty of the nursing staff to keep the anesthesiologist informed of the patient’s condition, and the duty of the doctor to ensure that that is done.
Injury and death can occur from many different complications during procedures involving anesthesia. Positioning injuries have long been recognized, and are usually the responsibility of the anesthesia staff. An extremely common and avoidable injury is ulnar neuropathy resulting from the mal-positioning of an arm on the operating table. Other compression and stretch injuries can also occur from improper positioning or inadequate padding during extended procedures.
During intubation, proper placement of the endotracheal tube is critical. The tube can be misdirected down the esophagus, which should be immediately recognized. Traumatic intubation may result in damage to the throat structures, such as the thyroid cartilage, voice box or larynyx. Mal-positioned endotracheal tubes can also cause serious injury to the lungs and heart.
Extubation, particularly after extended procedures, carries the risk of trauma as well, as tissues may be adherent to the endotracheal tube. Emesis and aspiration are common complications immediately after extubation.
The administration of proper medication levels is critical. Pharmaceutical mistakes may also occur in the operating room by anesthesia staff. Other anesthesia injuries can occur from drug reactions and adverse interactions. Some drug reactions will be unpredictable, but it is the job of the anesthesia staff to anticipate likely adverse reactions and to be prepared to manage them accordingly. Adverse interactions can be avoided by careful attention to the medications the patient is already taking.
Another growing concern in anesthesia care is when the patient wakes up during surgery. With “anesthesia awareness,” a patient may be conscious, and in pain, but unable to communicate with the medical staff. According to the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), this may occur 20,000 to 40,000 times per year, and has led to the filing of over a dozen cases in recent years.
If you feel that you or a loved has suffered harm as a result of an anesthesia related mistake, contact a Fodera Long & Lalli medical malpractice attorney as soon as possible. Our experienced trial attorneys can help you secure all of the compensation to which you may be entitled as a result of improper anesthesia medical care.