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Anesthesia Errors

Undergoing a surgical procedure no matter how serious, whether it is elective or mandatory, can be a stressful event. The risk associated with the anesthesia is often much more dangerous than the actual medical procedure itself.  Approximately 82% of all anesthesia complications are a direct result of human error. Why do anesthesia mistakes happen? While many different variables account for why anesthesia mistakes happen they generally fall into two broad categories: (1) the failure to properly monitor all the patient and (2) anesthesia medication errors. Time is money, and unfortunately, in the rush to move patients through the hospital or doctor’s office, and the growing insurance costs associated with and long hours put in by overworked medical staff, accidents do happen. However, when you or a loved one is the victim of an anesthesia mistake someone needs to be accountable.

If the anesthesiologist fails to closely monitor the patient, the following problems may cause injury:

  • Inadequate explanation of procedure requirements before, during, and after anesthesia
  •  Poor communication in the surgical room
  •  Delayed anesthesia administration
  •  Not enough anesthesia to keep patient sedated
  •  Overdose of anesthesia
  •  Failed or inadequate intubation
  •  Extensive sedation time, that is longer than intended
  •  Failure to identify or react to medication difficulties
  •  Failure to properly administer oxygen
  •  Equipment mistakes, such as turning off alarms or allowing concentrated oxygen near hot surgical devices

During surgery, three drugs are typically given to patients. First, a drug is administered to put the patient to sleep, secondly, a painkiller and lastly a paralytic that prevents the patient from moving. Paralysis is what prevents the patient from being able to communicate with the medical staff when the anesthesia fails. Anesthesia awareness is one of the anesthesia mistakes that occur when a patient is put under general anesthesia, yet is fully aware of what is going on around them. It is a terrifying experience in that the patient is mentally aware of everything, however paralyzed and unable to alert the medical staff of their awareness. This is a horrific experience and patients who have had anesthesia awareness happen to them often experience Post Traumatic Stress Syndrome. They often require months of therapy, and acquire a fear of surgical procedures. According to a report by the Joint Commission on the Accreditation of Healthcare Organizations, anesthesia awareness occurs at an alarming rate of approximately 20,000 to 40,000 cases per year. This is approximately 1 to 2 per 1,000 people who are put under anesthesia. Approximately half of those who wake up can hear or feel what is happening to them, and approximately 30 percent feel pain.

These numbers are amazing and have caused the Joint Commission to issue an alert, calling anesthesia awareness an under-recognized and under-treated problem in health care organizations. A recent study found that 100 patients wake up every single day in operating rooms in the United States. Patients are often unwilling or afraid to tell their doctors for fear of the doctor’s thinking they are crazy or hallucinating. Other side effects of improper anesthesia use include:

  •  Asphyxiation
  •  Anaphylaxis
  •  Tracheal damage
  •  Birth defects
  •  Pulmonary aspiration of gastric contents
  •  Hypertension
  •  Cardiac dysrhythmia
  •  Myocardial infarction, or minor heart attack
  •  Major heart attack
  •  Stroke
  •  Coma
  •  Severe brain damage
  •  Death

Anesthesia mistakes are not limited to hospital operating rooms. Incidents occur in dental offices and cosmetic surgery offices and include not only anesthesiologists but also, nurses, nurse anesthetists, residents in training, nurse practitioners, surgeons, dentists and other doctors. Prevention is obviously the key word in anesthesia mistakes.

Record keeping plays a key role in patient safety. Charts should constantly be updated and referred to by the anesthesia staff. Additions and alterations should be reviewed, noted and discussed with the patient. An exam and interview with the patient should include the anesthetist and informed consent forms signed and reviewed with the patient along with the patient’s records, physician orders, allergic reactions to medications and postoperative records. At this time, the staff will make notes in the records assuring a thorough review. Communication between the surgical team is a vital part of the procedure and a step that is often compromised due to fatigue, ego problems, personality conflicts and simply the rush to complete the surgery and move on to the next. Notations should also be made of all staff involved in the procedure, including nurses, anesthesiologists, scrub nurses, assistants, etc. It should also be noted that if a mistake does occur, the records should be closely examined, with close attention to neatness, removed staples, pages in correct order etc. Due to new HIPPA laws, the patient has the right to request an audit trail.

During the procedure, often times the technicians lack the proper training needed to administer anesthesia. Many hospitals rely on ‘on the job’ training, at times unknowingly making the patient the experimental project. At this point if records are not closely read, a technician may unknowingly administer a drug with an adverse effect, thus causing a possible stroke or even worse cardiac arrest. Monitoring of all bodily functions should be done constantly. These include, blood pressure, intravenous lines, electrocardiograms that monitor the heart function, and pulse oximetry to monitor the oxygen level of the blood.

Constant monitoring of medications is essential along with fluid outputs, which include urine and blood. All of these statistics should be recorded at five-minute intervals. No matter how technically advanced the operating room, handwritten notes should be constantly recorded along with the records preserved by the monitoring equipment. Not until the patient is stable should they be discharged from the operating room. While in the recovery unit, the same level of monitoring should be done at close intervals. Depending on the surgical procedure certain criteria must be met before the patient is discharged either to the floor or released to their home. While medical institutions historically keep intricate records, the same cannot often be said for small clinics. Records are often simply not recorded properly or lost due to moves or re-filing procedures. Discovery in these cases is often very difficult.

Injuries vary greatly in anesthesia mistakes, from positioning of the body causing compression of nerves resulting in neuropathy to improper placement of the endotracheal tube. Extubation is also very critical as tissues may become adhered to the tube causing tearing. Recording of medication levels during surgery is an imperative step. A medication administered and not recorded can easily lead to additional doses being administered at a much higher level than is tolerated by the patient. Adverse reactions to medications should also be noted by staff and if found to have occurred, the situation should be dealt with accordingly, immediately, and properly recorded.

Anesthesia medical mistakes can be incredibly difficult to prove. Handling these cases requires a highly skilled legal team experienced in medical malpractice. A high degree of detective work combined with medical knowledge and understanding of policies and procedures is essential. Records must be preserved immediately to prevent tampering. If you or a loved one has experienced an anesthesia mistake, it is in your best interest to contact a legal expert as soon as you suspect a problem. Please contact The O’Keefe Firm today at 937-630-0600 for free no obligation consultation with an anesthesia error lawyer.