Injury and Liability Associated with Monitored Anesthesia Care

2006 ◽  
Vol 104 (2) ◽  
pp. 228-234 ◽  
Author(s):  
Sanjay M. Bhananker ◽  
Karen L. Posner ◽  
Frederick W. Cheney ◽  
Robert A. Caplan ◽  
Lorri A. Lee ◽  
...  
Keyword(s):  
General Anesthesia ◽  
Respiratory Depression ◽  
Brain Damage ◽  
Regional Anesthesia ◽  
Supplemental Oxygen ◽  
Anesthesia Care ◽  
Monitored Anesthesia Care ◽  
Malpractice Claims ◽  
American Society ◽  
Permanent Brain Damage

Background To assess the patterns of injury and liability associated with monitored anesthesia care (MAC) compared with general and regional anesthesia, the authors reviewed closed malpractice claims in the American Society of Anesthesiologists Closed Claims Database since 1990. Methods All surgical anesthesia claims associated with MAC (n = 121) were compared with those associated with general (n = 1,519) and regional (n = 312) anesthesia. A detailed analysis of MAC claims was performed to identify causative mechanisms and liability patterns. Results MAC claims involved older and sicker patients compared with general anesthesia claims (P < 0.025), often undergoing elective eye surgery (21%) or facial plastic surgery (26%). More than 40% of claims associated with MAC involved death or permanent brain damage, similar to general anesthesia claims. In contrast, the proportion of regional anesthesia claims with death or permanent brain damage was less (P < 0.01). Respiratory depression, after absolute or relative overdose of sedative or opioid drugs, was the most common (21%, n = 25) specific damaging mechanism in MAC claims. Nearly half of these claims were judged as preventable by better monitoring, including capnography, improved vigilance, or audible alarms. On-the-patient operating room fires, from the use of electrocautery, in the presence of supplemental oxygen during facial surgery, resulted in burn injuries in 20 MAC claims (17%). Conclusion Oversedation leading to respiratory depression was an important mechanism of patient injuries during MAC. Appropriate use of monitoring, vigilance, and early resuscitation could have prevented many of these injuries. Awareness and avoidance of the fire triad (oxidizer, fuel, and ignition source) is essential to prevent on-the-patient fires.

Regional Anesthesia for Arteriovenous Fistula Surgery May Reduce Hospital Length of Stay and Reoperation Rates

2018 ◽  
Vol 52 (6) ◽  
pp. 418-426 ◽  
Author(s):  
Naida M. Cole ◽  
Kamen Vlassakov ◽  
Ethan Y. Brovman ◽  
Mahyar Heydarpour ◽  
Richard D. Urman
Keyword(s):  
Length Of Stay ◽  
General Anesthesia ◽  
Arteriovenous Fistula ◽  
Regional Anesthesia ◽  
Lower Risk ◽  
Anesthesia Care ◽  
Monitored Anesthesia Care ◽  
Improvement Project ◽  
Fistula Surgery ◽  
Postoperative Length

Background and Objectives: Regional anesthesia has been proposed as the preferred mode of anesthesia for arteriovenous fistula surgery due to its associated vasodilatory effects and fistula patency rates. We analyzed patient outcomes after arteriovenous fistula surgery for their association with the type of anesthesia received. Methods: The National Surgical Quality Improvement Project database was accessed to identify a cohort of 3199 patients undergoing arteriovenous fistula surgery from 2007 to 2015. Multiple regression models were used to examine the association of anesthesia with 12 postoperative outcomes. Additional multivariate logistic regression was performed to assess significant independent variables predictive of anesthesia choice. Results: Patients who received regional anesthesia had the shortest postoperative length of stay (0.67 [standard deviation: 2.0] days) compared to monitored anesthesia care/intravenous (IV) sedation (0.77 [1.8] days) and general anesthesia (1.44 [2.8] days). Administration of regional anesthesia was associated with a shorter length of stay compared to general anesthesia (odds ratio [OR]: 0.55, P = .001). Patients who received monitored anesthesia care/IV sedation had a lower risk of reoperation compared to general anesthesia (OR: 0.65, P = .012) but not compared to regional anesthesia (OR: 0.89, P = .759). Anesthesia type had no significant effects on other measured postoperative complications. Predictors of the type of anesthesia were age and surgical procedure as defined by Current Procedural Terminology code ( P < .001). Conclusions: Use of regional anesthesia is associated with a shorter postoperative length of stay after arteriovenous fistula surgery and lower risk of reoperation compared to general anesthesia or monitored anesthesia care/IV sedation. Regional anesthesia may be an excellent choice for arteriovenous fistula surgery to reduce postoperative length of stay and risk of reoperation.

scholarly journals Analysis of urgent/emergent conversions from monitored anesthesia care to general anesthesia with airway instrumentation

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Sang Kim ◽  
Brian A. Chang ◽  
Amreen Rahman ◽  
Hung-Mo Lin ◽  
Samuel DeMaria ◽  
...  
Keyword(s):  
Risk Factors ◽  
General Anesthesia ◽  
Mount Sinai Hospital ◽  
Anesthesia Care ◽  
Monitored Anesthesia Care ◽  
Surgical Specialty ◽  
Factors Associated ◽  
Physical Status Classification ◽  
American Society ◽  
American Society Of Anesthesiologists

Abstract Background Monitored Anesthesia Care (MAC) is an anesthetic service involving the titration of sedatives/analgesics to achieve varying levels of sedation while avoiding general anesthesia (GA) and airway instrumentation. The goal of our study was to determine the overall incidence of conversion from MAC to general anesthesia with airway instrumentation and elucidate reasons and risk factors for conversion. Methods In this retrospective observational study, all non-obstetric adult patients who received MAC from July 2002 to July 2015 at Mount Sinai Hospital were electronically screened for inclusion via a clinical database. Patient, procedure, anesthetic, and practitioner data were all collected and analyzed to generate descriptive analyses. Subsequent univariate and multivariate analyses were used to identify specific risk factors associated with conversion to GA. Results Overall, 0.50% (1097/219,061) of MAC cases were converted to GA. Approximately half of conversions were due to the patient’s “intolerance” of MAC (with or without failed regional anesthesia), while the other half were due to physiologic derangements. Body mass index, male sex, American Society of Anesthesiologists Physical Status Classification, anesthesia team composition, and surgical specialty were all associated with risk of conversion to GA. Conclusions This is one of the first and largest retrospective studies aimed at identifying reasons and risk factors associated with the conversion of MAC to GA. These findings may be used to help better anticipate or prevent these events.

Operating Room Fires

2013 ◽  
Vol 118 (5) ◽  
pp. 1133-1139 ◽  
Author(s):  
Sonya P. Mehta ◽  
Sanjay M. Bhananker ◽  
Karen L. Posner ◽  
Karen B. Domino
Keyword(s):  
Operating Room ◽  
Delivery System ◽  
Critical Role ◽  
Fire Risk ◽  
Supplemental Oxygen ◽  
Ignition Source ◽  
Anesthesia Care ◽  
Monitored Anesthesia Care ◽  
Malpractice Claims ◽  
Or Fires

Abstract Background: To assess patterns of injury and liability associated with operating room (OR) fires, closed malpractice claims in the American Society of Anesthesiologists Closed Claims Database since 1985 were reviewed. Methods: All claims related to fires in the OR were compared with nonfire-related surgical anesthesia claims. An analysis of fire-related claims was performed to identify causative factors. Results: There were 103 OR fire claims (1.9% of 5,297 surgical claims). Electrocautery was the ignition source in 90% of fire claims. OR fire claims more frequently involved older outpatients compared with other surgical anesthesia claims (P &lt; 0.01). Payments to patients were more often made in fire claims (P &lt; 0.01), but payment amounts were lower (median $120,166) compared to nonfire surgical claims (median $250,000, P &lt; 0.01). Electrocautery-induced fires (n = 93) increased over time (P &lt; 0.01) to 4.4% claims between 2000 and 2009. Most (85%) electrocautery fires occurred during head, neck, or upper chest procedures (high-fire-risk procedures). Oxygen served as the oxidizer in 95% of electrocautery-induced OR fires (84% with open delivery system). Most electrocautery-induced fires (n = 75, 81%) occurred during monitored anesthesia care. Oxygen was administered via an open delivery system in all high-risk procedures during monitored anesthesia care. In contrast, alcohol-containing prep solutions and volatile compounds were present in only 15% of OR fires during monitored anesthesia care. Conclusions: Electrocautery-induced fires during monitored anesthesia care were the most common cause of OR fires claims. Recognition of the fire triad (oxidizer, fuel, and ignition source), particularly the critical role of supplemental oxygen by an open delivery system during use of the electrocautery, is crucial to prevent OR fires. Continuing education and communication among OR personnel along with fire prevention protocols in high-fire-risk procedures may reduce the occurrence of OR fires.

Trends in Anesthesia-related Death and Brain Damage

2006 ◽  
Vol 105 (6) ◽  
pp. 1081-1086 ◽  
Author(s):  
Frederick W. Cheney ◽  
Karen L. Posner ◽  
Lorri A. Lee ◽  
Robert A. Caplan ◽  
Karen B. Domino
Keyword(s):  
Carbon Dioxide ◽  
Pulse Oximetry ◽  
Brain Damage ◽  
Adverse Outcomes ◽  
Malpractice Claims ◽  
End Tidal Carbon Dioxide ◽  
Carbon Dioxide Monitoring ◽  
Permanent Brain Damage ◽  
End Tidal ◽  
Closed Claims

Background The authors used the American Society of Anesthesiologists Closed Claims Project database to determine changes in the proportion of claims for death or permanent brain damage over a 26-yr period and to identify factors associated with the observed changes. Methods The Closed Claims Project is a structured evaluation of adverse outcomes from 6,894 closed anesthesia malpractice claims. Trends in the proportion of claims for death or permanent brain damage between 1975 and 2000 were analyzed. Results Claims for death or brain damage decreased between 1975 and 2000 (odds ratio, 0.95 per year; 95% confidence interval, 0.94-0.96; P &lt; 0.01). The overall downward trend did not seem to be affected by the use of pulse oximetry and end-tidal carbon dioxide monitoring, which began in 1986. The use of these monitors increased from 6% in 1985 to 70% in 1989, and thereafter varied from 63% to 83% through the year 2000. During 1986-2000, respiratory damaging events decreased while cardiovascular damaging events increased, so that by 1992, respiratory and cardiovascular damaging events occurred in approximately the same proportion (28%), a trend that continued through 2000. Conclusion The significant decrease in the proportion of claims for death or permanent brain damage from 1975 through 2000 seems to be unrelated to a marked increase in the proportion of claims where pulse oximetry and end-tidal carbon dioxide monitoring were used. After the introduction and use of these monitors, there was a significant reduction in the proportion of respiratory and an increase in the proportion of cardiovascular damaging events responsible for death or permanent brain damage.

Practice Guidelines for the Prevention, Detection, and Management of Respiratory Depression Associated with Neuraxial Opioid Administration

2016 ◽  
Vol 124 (3) ◽  
pp. 535-552 ◽  
Keyword(s):  
Respiratory Depression ◽  
Regional Anesthesia ◽  
Practice Guidelines ◽  
Task Force ◽  
Digital Content ◽  
Pain Medicine ◽  
Practice Parameters ◽  
Opioid Administration ◽  
American Society ◽  
American Society Of Anesthesiologists

Abstract The American Society of Anesthesiologists Committee on Standards and Practice Parameters and the Task Force on Neuraxial Opioids and the American Society of Regional Anesthesia and Pain Medicine present an updated report of the Practice Guidelines for the Prevention, Detection, and Management of Respiratory Depression Associated with Neuraxial Opioid Administration. Supplemental Digital Content is available in the text.

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