In studies of closed claims since 1990 involving anesthesia medical malpractice, it was found that death or brain damage was involved in 31% to 32% of the claims. Death or brain damage was caused by a respiratory issue in 45% of these cases and involved inadequate ventilation in 7% of the cases, esopageal intubation in 7% of the cases, and difficult intubation in 12% of the cases. A cardiovascular issue was involved in 25% of the death or brain damage claims (up from 13% in the 1970s).
The next common basis for claims of anesthesia medical malpractice in the closed claims that were reviewed was nerve injury (21%), followed by airway injury (8%), burns (6%), awareness or emotional distress (5%), eye injury (5%), backache (5%), pneumothorax (4%), aspiration pneumonitis (3%), and newborn injury (1.5%).
Pulse oximetry monitoring during surgeries became standard in 1990 and subsequently death or brain damage due to inadequate ventilation decreased significantly when pulse oximetry was used.
Requiring end-tidal carbon dioxide verification of endotracheal intubation has resulted in reduced claims for death or brain damage caused by esophageal intubation (more recent widespread use of the laryngeal mask airway has also significantly reduced these claims).
Since practice guidelines were published in 1993 for management of the difficult airway, deaths or brain damage due to difficult airway issues were reduced from 62% to 35%.
Aspiration was involved as the primary or secondary issue in 3.5% of all anesthsia medical malpractice claims (67% occurred during intubation). Aspiration was involved in 60% of the death or brain injury claims versus 43% for nonaspirational claims (widespread use of the laryngeal mask airway has subsequently reduced these claims).
Airway trauma was implicated in 6% of the anesthesia medical malpractice claims, of which 38% involved difficult intubation and 9% resulted in death or brain damage. Injuries involved the larynx in 34% of the cases (resulting in vocal cord paralysis in 31% of these cases), the pharynx in 17% of the cases, the esophagus in 16% of the cases, the trachea in 14% of the cases, and the temporomandibular joint in 10% of the cases.
The most common nerve injury claimed in anesthesia medical malpractice claims was for injury to the ulnar nerve (25%, of which 86% were claimed to have occurred using general anesthesia), followed by injury to the brachial plexus (19%). The use of padding was undocumented in 57% of the claims involving nerve injury, patient positioning was undocumented in 55%, and improper patient positioning was involved in 36% of the claims. Since 1990, spinal cord injuries have surpassed ulnar nerve injuries.
Burns were involved in 2% of the anesthesia medical malpractice claims and involved IV bags or bottles (35%), warmers (23%), cautery fires (19%), cautery burns without fire (12%), lasers in the airway (2%), MRI at the site of pulse oximetry (2%), retractors (1%), defibrillator paddles (1%), and electrocardiographic leads (1%). 93% of the burns were either temporary or non-disabling.
With regard to postoperative visual loss claims, 81% were related to ischemic optic neuropathy and were associated with large blood loss, prolonged hypertension, prone position, and vaso-occlusive disease. An additional 13% of the claims were due to central retinal artery occlusion associated with direct pressure on the globe, emboli, and low retinal profusion pressure. 39% of those sustaining ischemic optic neuropathy recovered at least partial sight but none of those who sustained central retinal artery occlusion regained sight.
Of the intraoperative awareness claimants, 75% could recall events during anesthesia (of these, 42% were due to substandard care). The remaining 25% were due to inadvertent paralysis of a conscious patient (94% to 96% of these cases were due to substandard care).
Medication errors were involved in 4% of the anesthesia medical malpractice claims of which the incorrect dosage was involved in 31% of the claims, substitution of the incorrect drug was involved in 24% of the claims, and the administration of a drug not intended to be given was involved in 17% of the claims.
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