Page 16 - Part 1 Anesthesiology Common Risk Issues
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SVMIC Anesthesiology: Common Risk Issues
claims directly rather than submitting them to their insurance
carrier.
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
was used. Shortly after the procedure began, the patient’s
oxygen saturation decreased. Intubation was unsuccessful,
and 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 (LMA) and to perform
this procedure in the ambulatory setting. The lacking
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.
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