Page 14 - 2022 Risk Basics - Anesthesiology

SVMIC Risk Basics: Anesthesiology

CASE STUDY

A 50-year-old male weighing 350 pounds with a known
history of difficult intubation underwent repair of umbilical

hernia on an outpatient basis. A laryngeal mask airway

(LMA) was used. Shortly after the procedure began, the
patient’s oxygen saturation decreased. Intubation was

unsuccessful, and an emergency tracheostomy was
performed. The patient suffered brain hypoxia and was

transferred to the hospital. He remained in a vegetative

state. A lawsuit was filed alleging improper management
of the patient’s airway during the procedure. A review of

the medical record showed inadequate documentation on
the pre-anesthesia evaluation.

Failure to complete and document a thorough pre-op

anesthesia evaluation presented a challenge to experts
trying to evaluate the rationale for the anesthesia plan to

use a laryngeal mask airway and to perform this procedure

in the ambulatory setting. The lack of documentation
allowed the plaintiff to allege successfully that the

anesthesia team did not have vital information about the
patient and, thus, were not prepared for the possibility of

airway difficulties and that this was clearly a departure
from the standard of care. This leads us to examine

important elements of the pre-anesthesia evaluation.

As the head of any anesthesia care team, the anesthesiologist

is responsible for the management of the anesthesia team and

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