Page 23 - 2022 Risk Basics - Anesthesiology

SVMIC Risk Basics: Anesthesiology

In a number of the claims, the anesthesia record lacked

detailed notes regarding cardiac activity ceasing during a
crisis, and there were major inconsistencies within the

operative record. The plaintiff was able to allege carelessness

and an improper emergency response. There were also
questions as to whether monitor alarms had been turned off. In

cases where there was an airway emergency leading to a
serious outcome such as hypoxic encephalopathy, the defense

was hampered by a lack of documentation of events that

unfolded or the maneuvers utilized for managing the difficult
airway. Negligent lack of attention to detail was alleged, and

this lack of documentation during an emergency was often
accompanied by an inadequate pre-anesthesia evaluation

and/or a boilerplate consent form such that essential details of

the risk of anesthesia appeared not to have been explored or
discussed.

Adverse anesthesia events can occur despite the sophisticated

monitors in use. Many adverse events should not occur but do
because alarms were never activated, were silenced during the

procedure, or had been silenced at the end of the prior case

and were not reactivated (be aware that some machines do
not automatically reset the alarm). Do not neglect pulse

oximeter and CO2 alarms. The ASA standards require that
alarms be audible to the anesthesiologist or member of the

anesthesia care team.
8

One of the anesthesiologist’s/CRNA’s top concerns is
difficulties with a patient’s airway causing serious

8 https://www.asahq.org/standards-and-guidelines/statement-on-the-anesthesia-care-team

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