Page 48 - Part 1 Anesthesiology Common Risk Issues

SVMIC Anesthesiology: Common Risk Issues

include: failure to develop an anesthesia plan, delegation

of duties that should not be delegated, unavailability of the
supervising physician, CRNA’s failure to timely request help, and

misunderstanding as to medicine, dosage, technique, allergies,
etc.

The following case study illustrates the type of communication

claims that can be asserted when there is a breakdown between
the anesthesiologist and the patient, especially when there is a

pre-procedure indication that difficulties may be encountered.

CASE STUDY

A 44-year-old female with a history of hypertension,

being a two pack-per-day smoker, and mild obesity was
diagnosed with an abdominal mass. The initial exploratory

laparotomy was cancelled due to an abnormal EKG. The
patient underwent a cardiac work-up which revealed LVH

(left ventricular hypertrophy) and mild aortic regurgitation.
After the work-up was complete, she was rescheduled for

surgery.

The anesthesiologist did not evaluate the patient prior

to surgery and was not present for the induction. A pre-

op evaluation was performed by the CRNA with ASA 3
assigned. The airway was judged to be within normal limits
on this evaluation and prior anesthetic history was negative

for any problems.

The patient was taken to the OR, monitors were placed, and
the CRNA began induction with Diprivan, Succinylcholine,

Versed, and Fentanyl. The anesthesiologist was not in the

continued on following page

Page 48