Page 21 - Part 2 Anesthesiology Common Risk Issues

SVMIC Anesthesiology: Common Risk Issues

C-sections, heart surgeries, and emergency/traumatic injury

surgeries most likely because the usual dose of required
anesthesia cannot be used safely. Patients are also more

likely to experience awareness with procedures that use local
anesthesia or intravenous (“twilight”) sedation rather than

general anesthesia such as colonoscopies. The incidence of
awareness doubles with the use of a paralytic agent. Finally,
8
patients who have a history of excessive alcohol and drug use
are at increased risk.

SVMIC’s claims experience with anesthetic awareness cases is

limited. A few have been asserted against our policyholders, but
to date, no loss payments have been made. That is not to say,

however, that all such claims are frivolous or should be taken
lightly.

To reduce the risk of anesthetic awareness, the anesthesiologist
should obtain as much information as possible under the

circumstances from the patient or representative about the
patient’s health including:

• Prior problems with anesthesia including being awake

• All medications the patient is taking or has recently taken

• History of drug or alcohol use

• Concerns about surgery including anesthesia awareness

The incidence of awareness is low when an inhalation agent is
used at 0.5 MAC or greater. End tidal volatile alarms are often

disabled because of technical challenges, but should always be
enabled to prevent awareness. Practitioners should also double-

8 Sandin RH et al: Awareness during anesthesia: a prospective case study. Lancet 2000Feb
26;355(9205):707-11

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