Over the past decades, better anesthesia drugs have been developed. It is better understood how these drugs affect the body and technology makes it easier to prevent complications, making surgery overall much safer for the patient. However, there are still cases where patients are injured, and attorneys have to determine whether or not it was due negligence. Looking at what factors contribute to patient injury, a defense or plaintiff attorney will prepare for a case. With the assistance from a medical expert witness, the complex details of anesthesia malpractice cases can be reviewed and understood to better present at trial. If you are handling a case that involves alleged malpractice of an anesthesiologist, contact APEXpert Witness to retain an expert witness.

Technical Aspects

Factors that contribute to patient injury are technical performance of and drug administration by an anesthesiologist. For example, the endotracheal tube was not inserted or removed properly, leading to esophageal intubation, to hard and soft palate injuries, laryngeal dysfunction, tracheomalacia, amongst others. A dosage of an anesthetic drug was incorrect or was administered improperly. Technical performance could also include incorrect body positioning or peripheral nerve injury. Some of the risks may be known by the patient before the procedure and they consented to it. Some of the events were a consequence of negligence, but some could also not be prevented even with the most diligent care. This is where it comes to the careful analysis by an experienced expert to determine what happened.

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Preoperative Evaluation

Every patient should be assessed by an anesthesiologist prior to surgery. The omission of a thorough assessment prior to surgery without diligent questioning and physical examination can have serious consequences. It may be missed that a patient has an increased risk for a certain procedure due to their underlying medical condition, and anesthetic techniques may have to be modified, and in some cases, the surgery even delayed, until the patient is in a better condition to have surgery and anesthesia. These conditions should be found in a pre-surgical examination. Questions have to be asked to gain knowledge of the patient’s history, for example, if there are known allergic reactions. At times, inadequate history and a superficial physical examination can lead to unexpected outcomes. There may also be a failure to acknowledge abnormal test results such as an abnormal EKG.

Lack of Documentation

Correct documentation is absolutely essential during anesthesia. Cases where documentation is missing, is inconsistent, or post-dated, can be difficult to defend in court, because it shows that caretakers did not do their due diligence, may not have been attentive or did not want to document a complication. Examples of a lack of proper documentation could be the occurrence of abnormally low blood pressures or oxygen saturations in a clinical setting, or unexpected resuscitation attempts. Explanations for the lack of documentation could either imply the anesthesiologists were not properly monitoring the patient’s vital signs, or failing to note what they were observing.

Medical ExpertPatient Monitoring

Improper monitoring of the patient can also lead to serious consequences. A substantial drop in the patient’s blood pressure, for example, that is not acknowledged by the anesthesiologist, or lack of response within an adequate amount of time may cause a stroke in a patient who has critical carotid artery stenosis. There is also potential for monitor alarms that sound but being ignored and not responded to, turned off, or not heard.

Patient Factors

Entirely unexpected complications will occur due to a patient’s medical condition or anatomy. These conditions include diabetes, cardiovascular disease, morbid obesity, and hypertension, and many others. Smoking also increases risks. Whereas patients are told ahead of time that many of these conditions will increase their overall risk with surgery and anesthesia, many surgeries are medically necessary, complications can be anticipated and accordingly prevented or treated, and it is rarely a result of negligence if something goes wrong.  

Other Factors

Various factors can increase the risk of patient injury.

  • Preparation for possible complications was not complete, including not having the appropriate equipment for clinical situations where the surgeon or anesthesiologist may need it.
  • After-effects of analgesic drugs, such as narcotics, leading to respiratory depression and arrest outside of a supervised environment such as a recovery room, hypoxia, and in the worst case, brain damage.
  • Extubation was done too soon after the surgery was complete.
  • Regional anesthesia was administered incorrectly, including placement or dosage, leading to nerve injury, which is fortunately very rare.

Anesthesiologists have to be aware of all these risk factors. However, malpractice cases may arise; in which case, negligence on behalf of the anesthesiologist needs to be proved or disproved. For an accurate review of the details of the case and all documentation involved, a medical expert who has an expertise in the anesthesia field may be needed. At APEXpert Witness, you can rely on our medical experts. For a trustworthy, professional witness in court, for depositions, or chart review, contact an expert medical witness today.