Anesthesia Errors & Medical Malpractice

Evaluation of the Anesthesia Case – Failure to Maintain a Patent Airway

The practice of anesthesiology is broad in scope extending from the control of pain and consciousness in the operating room or elsewhere to the control of pain generally in the hospital or even in the outpatient setting. In the operating room, the anesthesiologist, in addition to having an extensive monitoring role, has independent responsibility for evaluating and supporting cardiopulmonary function. Because of their monitoring functions, anesthesiologists, as a rule, document their activities contemporaneously and more thoroughly than any healthcare provider other than perhaps the critical care nurse. In addition, because errors in the administration of anesthesia can result in catastrophic injuries (which in the past were often preventable) the specialty has evolved more thorough and rigid guidelines than most medical specialties. Anesthesiologists have also benefited from the advent of safeguards such as continuous pulse oximetry and continuous mean arterial pressure and blood pressure monitoring systems. Notwithstanding the rigid guidelines and all the technologic advances, there are still serious preventable injuries, which occur and are entirely the responsibility of anesthesiologists. The one which I choose to address in this article will be airway management.

A completely healthy human being cannot survive more than a few minutes of apnea (absent ventilation) without suffering serious injury and in some cases severe brain damage or death. Nevertheless, at the beginning of every surgical procedure where inhalation anesthesia is to be employed, there is an intentional period of apnea artificially induced by the administration of paralytic drugs to enable the anesthesiologist to pass a tube through the oral pharynx into the trachea in order to secure the patient’s airway for the administration of assisted ventilation and inhalation anesthesia. Sometimes when the patient’s spontaneous ventilation have been intentionally eliminated by the use of paralytic drugs, there is difficulty in securing the airway and the anesthesiologist then experiences what most anesthesiologists regard as their worst nightmare (though it is truly a greater nightmare for the patient’s family). A patient’s ability to self ventilate has been eliminated intentionally and routinely. An airway cannot be passed or an airway is passed but a patient cannot be ventilated through the airway. The patient cannot self ventilate because of the paralytic agent. The patients dies. Alternatively, the patient is successfully ventilated ultimately but suffers severe brain damage because of the interval of apnea. The patient then subsequently either dies or is left in a comatose state.

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