scholarly journals Pulmonary Aspiration of Gastric Contents: A Closed Claims Analysis

2021 ◽  
Author(s):  
Mark A. Warner ◽  
Karen L. Meyerhoff ◽  
Mary E. Warner ◽  
Karen L. Posner ◽  
Linda Stephens ◽  
...  
Keyword(s):  
Anesthetic Management ◽  
Pulmonary Aspiration ◽  
Anesthesia Care ◽  
Inclusion Criteria ◽  
Gastrointestinal Obstruction ◽  
Malpractice Claims ◽  
Gastric Contents ◽  
American Society ◽  
Closed Claims ◽  
American Society Of Anesthesiologists

Background Perioperative pulmonary aspiration of gastric contents has been associated with severe morbidity and death. The primary aim of this study was to identify outcomes and patient and process of care risk factors associated with gastric aspiration claims in the Anesthesia Closed Claims Project. The secondary aim was to assess these claims for appropriateness of care. The hypothesis was that these data could suggest opportunities to reduce either the risk or severity of perioperative pulmonary aspiration. Methods Inclusion criteria were anesthesia malpractice claims in the American Society of Anesthesiologists Closed Claims Project that were associated with surgical, procedural, or obstetric anesthesia care with the year of the aspiration event 2000 to 2014. Claims involving pulmonary aspiration were identified and assessed for patient and process factors that may have contributed to the aspiration event and outcome. The standard of care was assessed for each claim. Results Aspiration of gastric contents accounted for 115 of the 2,496 (5%) claims in the American Society of Anesthesiologists Closed Claims Project that met inclusion criteria. Death directly related to pulmonary aspiration occurred in 66 of the 115 (57%) aspiration claims. Another 16 of the 115 (14%) claims documented permanent severe injury. Seventy of the 115 (61%) patients who aspirated had either gastrointestinal obstruction or another acute intraabdominal process. Anesthetic management was judged to be substandard in 62 of the 115 (59%) claims. Conclusions Death and permanent severe injury were common outcomes of perioperative pulmonary aspiration of gastric contents in this series of closed anesthesia malpractice claims. The majority of the patients who aspirated had either gastrointestinal obstruction or acute intraabdominal processes. Anesthesia care was frequently judged to be substandard. These findings suggest that clinical practice modifications to preoperative assessment and anesthetic management of patients at risk for pulmonary aspiration may lead to improvement of their perioperative outcomes. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New

Awareness during Anesthesia 

1999 ◽  
Vol 90 (4) ◽  
pp. 1053-1061 ◽  
Author(s):  
Karen B. Domino ◽  
Karen L. Posner ◽  
Robert A. Caplan ◽  
Frederick W. Cheney
Keyword(s):  
General Anesthesia ◽  
Elective Surgery ◽  
Anesthetic Techniques ◽  
Post Traumatic Stress ◽  
Intraoperative Awareness ◽  
Malpractice Claims ◽  
Depth Analysis ◽  
American Society ◽  
Closed Claims ◽  
American Society Of Anesthesiologists

Background Awareness during general anesthesia is a frightening experience, which may result in serious emotional injury and post-traumatic stress disorder. We performed an in-depth analysis of cases from the database of the American Society of Anesthesiologists Closed Claims Project to explore the contribution of intraoperative awareness to professional liability in anesthesia. Methods The database of the Closed Claims Project is composed of closed US malpractice claims that have been collected in a standardized manner. All claims for intraoperative awareness were reviewed by the reviewers to identify patterns of causation and standard of care. Logistic regression analysis was used to identify independent patient and anesthetic factors associated with claims for recall during general anesthesia compared to other general anesthesia malpractice claims. Results Awareness claims accounted for 79 (1.9%) of 4,183 claims in the database, including 18 claims for awake paralysis, i.e., the inadvertent paralysis of an awake patient, and 61 claims for recall during general anesthesia, ie., recall of events while receiving general anesthesia. The majority of awareness claims involved women (77%), younger than 60 yr of age (89%), American Society of Anesthesiologists physical class I-II (68%), who underwent elective surgery (87%). Most (94%) claims for awake paralysis represented substandard care involving errors in labeling and administration, whereas care was substandard in only 43% of the claims for recall during general anesthesia (P < 0.001). Claims for recall during general anesthesia were more likely to involve women (odds ratio [OR] = 3.08, 95% confidence interval [CI] = 1.58, 6.06) and anesthetic techniques using intraoperative opioids (OR = 2.12, 95% CI = 1.20, 3.74), intraoperative muscle relaxants (OR = 2.28, 95% CI = 1.22, 4.25), and no volatile anesthetic (OR = 3.20, 95% CI = 1.88, 5.46). Conclusions Deficiencies in labeling and vigilance were common causes for awake paralysis. Claims for recall during general anesthesia were more likely in women and with nitrous-narcotic-relaxant techniques.

scholarly journals Autopsy Utilization in Medicolegal Defense of Anesthesiologists

2011 ◽  
Vol 115 (4) ◽  
pp. 713-717 ◽  
Author(s):  
Lorri A. Lee ◽  
Linda S. Stephens ◽  
Corinne L. Fligner ◽  
Karen L. Posner ◽  
Frederick W. Cheney ◽  
...  
Keyword(s):  
Cause Of Death ◽  
Statistical Significance ◽  
Chi Square ◽  
Autopsy Findings ◽  
New Information ◽  
Malpractice Claims ◽  
Hospital Deaths ◽  
American Society ◽  
Chi Square Analysis ◽  
Closed Claims

Background The rate of autopsy in hospital deaths has declined from more than 50% to 2.4% over the past 50 yr. To understand the role of autopsies in anesthesia malpractice claims, we examined 980 closed claims for deaths that occurred in 1990 or later in the American Society of Anesthesiologists Closed Claims Project Database. Methods Deaths with autopsy were compared with deaths without autopsy. Deaths with autopsy were evaluated to answer the following four questions: Did autopsy findings establish a cause of death? Did autopsy provide new information? Did autopsy identify a significant nonanesthetic contribution to death? Did autopsy help or hurt the defense of the anesthesiologist? Reliability was assessed by κ scores. Differences between groups were compared with chi-square analysis and Kolmogorov-Smirnov test with P < 0.05 for statistical significance. Results Autopsies were performed in 551 (56%) of 980 claims for death. Evaluable autopsy information was available in 288 (52%) of 551 claims with autopsy. Patients in these 288 claims were younger and healthier than those in claims for death without autopsy (P < 0.01). Autopsy provided pathologic diagnoses and an unequivocal cause of death in 21% of these 288 claims (κ= 0.71). An unexpected pathologic diagnosis was found in 50% of claims with evaluable autopsy information (κ = 0.59). Autopsy identified a significant nonanesthetic contribution in 61% (κ = 0.64) of these 288 claims. Autopsy helped in the defense of the anesthesiologist in 55% of claims and harmed the defense in 27% (κ = 0.58) of claims with evaluable autopsy information. Conclusions Autopsy findings were more often helpful than harmful in the medicolegal defense of anesthesiologists. Autopsy identified a significant nonanesthetic contribution to death in two thirds of claims with evaluable autopsy information.

scholarly journals Dexmedetomidine use during epiduroscopy reduces fentanyl use and postoperative nausea and vomiting: A single-center retrospective study

2018 ◽  
Vol 6 ◽  
pp. 205031211875680 ◽  
Author(s):  
Takashi Suzuki ◽  
Ryota Inokuchi ◽  
Kazuo Hanaoka ◽  
Machi Suka ◽  
Hiroyuki Yanagisawa
Keyword(s):  
Retrospective Study ◽  
Postoperative Nausea ◽  
Postoperative Nausea And Vomiting ◽  
Nausea And Vomiting ◽  
Anesthesia Care ◽  
Low Back ◽  
Monitored Anesthesia Care ◽  
History Of ◽  
American Society ◽  
American Society Of Anesthesiologists

Objectives: Minimally invasive epiduroscopy has recently been reported as an effective treatment procedure for chronic and intractable low back pain. However, no study has determined safe anesthetics for monitored anesthesia care during epiduroscopy. We aimed to compare and evaluate conventional monitored anesthesia care drugs with dexmedetomidine. Methods: A retrospective study including all patients who underwent epiduroscopy at the JR Tokyo General Hospital from April 2011 to March 2016 was designed. The epiduroscopy procedures were performed under anesthesia with dexmedetomidine plus fentanyl (dexmedetomidine group) or droperidol plus fentanyl (neuroleptanalgesia group). Patients who received analgesics other than fentanyl, another analgesic combined with fentanyl, any sedative other than dexmedetomidine or droperidol, or who had incomplete data were excluded. We compared (1) the type and dose of medication during the epiduroscopy and (2) the incidence of postoperative nausea and vomiting. Results: We identified 45 patients (31 and 14 in the dexmedetomidine and neuroleptanalgesia groups, respectively) with a mean age of 69.0 years. The two groups had comparable characteristics, such as age, sex, body mass index, the American Society of Anesthesiologists Physical Status, analgesics used in the clinic, comorbidities, history of smoking, and the duration of anesthesia. The dexmedetomidine group received a significantly lower fentanyl dose during surgery (126 ± 14 vs 193 ± 21 µg, mean ± standard deviation, p = 0.014) and exhibited a significantly lower incidence of postoperative nausea and vomiting (1 vs 3, p = 0.047) than the neuroleptanalgesia group. Conclusion: This study involved elderly patients, and the use of dexmedetomidine in monitored anesthesia care during epiduroscopy procedures in these patients may reduce the required fentanyl dose during surgery and the incidence of postoperative nausea and vomiting. This strategy may help prevent respiratory depression and aspiration.

The American Society of Anesthesiologists Closed Claims Project and Its Registries

2008 ◽  
Vol 36 (1) ◽  
pp. 19-31
Author(s):  
Karen B Domino ◽  
Robert A Caplan ◽  
Jeffrey P Morray ◽  
Lorri A Lee
Keyword(s):  
American Society ◽  
Closed Claims ◽  
American Society Of Anesthesiologists

The American Society of Anesthesiologists Closed Claims Project

2010 ◽  
Vol 113 (4) ◽  
pp. 957-960 ◽  
Author(s):  
Frederick W. Cheney ◽  
David S. Warner
Keyword(s):  
American Society ◽  
Closed Claims ◽  
American Society Of Anesthesiologists

Morbidity and mortality associated with anesthetic management in small animal veterinary practice in Ontario

1998 ◽  
Vol 34 (4) ◽  
pp. 325-335 ◽  
Author(s):  
DH Dyson ◽  
MG Maxie ◽  
D Schnurr
Keyword(s):  
Cardiac Arrest ◽  
Management Practices ◽  
Anesthetic Management ◽  
Small Animal ◽  
Morbidity And Mortality ◽  
Logistic Regression Models ◽  
Significant Odds Ratio ◽  
American Society ◽  
A Prospective Study ◽  
American Society Of Anesthesiologists

During 1993, 66 small animal practices participated in a prospective study to evaluate the incidence and details of anesthetic-related morbidity and mortality. Considering a total of 8,087 dogs and 8,702 cats undergoing anesthesia, the incidences of complications were 2.1% and 1.3%, respectively. Death occurred in 0.11% and 0.1% of cases, respectively. Logistic regression models were developed and showed that a significant odds ratio (OR) of complications in dogs was associated with xylazine (OR, 91.5); heart rate monitoring (OR, 3.2); American Society of Anesthesiologists (ASA) 3, 4, or 5 classification (OR, 2.5); isoflurane (OR, 2.4); butorphanol (OR, 0.35); technician presence (OR, 0.26); acepromazine (OR, 0.24); ketamine (OR, 0.21); and mask induction (OR, 0.2). Complications in cats were associated with ASA 3, 4, or 5 classification (OR, 5.3); diazepam (OR, 4.1); intubation (OR, 1.7); butorphanol (OR, 0.45); and ketamine (OR, 0.17). Cardiac arrest in dogs was associated with xylazine (OR, 43.6) and ASA 3, 4, or 5 classification (OR, 7.1). Cardiac arrest in cats was associated with ASA 3, 4, or 5 classification (OR, 21.6) and technician presence (OR, 0.19). This paper reports the incidences of complications and cardiac arrest in small animal practice and identifies common complications and factors that may influence anesthetic morbidity and mortality. This information may be useful in comparing anesthetic management practices.

Cricoid Cartilage Pressure Decreases Lower Esophageal Sphincter Tone

1997 ◽  
Vol 86 (1) ◽  
pp. 7-9 ◽  
Author(s):  
Jean-Pierre Tournadre ◽  
Dominique Chassard ◽  
Khalid R. Berrada ◽  
Paul Bouletreau
Keyword(s):  
Lower Esophageal Sphincter ◽  
Cricoid Pressure ◽  
Cricoid Cartilage ◽  
Pulmonary Aspiration ◽  
Human Volunteers ◽  
Gastric Pressure ◽  
Manometric Method ◽  
Esophageal Sphincter ◽  
American Society ◽  
American Society Of Anesthesiologists

Background Cricoid cartilage pressure induced to prevent pulmonary aspiration from regurgitation of gastric contents has been recommended, and its efficacy requires a force greater than 40 Newtons. For regurgitation to occur, both an increase in gastric pressure and relaxation of the lower esophageal sphincter (LES) are necessary. However, the effect of cricoid cartilage pressure on the LES is unknown. This study evaluated the effects of cricoid cartilage pressure on LES in human volunteers. Methods Lower esophageal sphincter and esophageal barrier pressures (which equals LES pressure-gastric pressure) were measured using a manometric method in eight unanesthetized volunteers (4 men, 4 women) classified as American Society of Anesthesiologists physical status 1. The force applied to the cricoid cartilage was measured continuously, and LES pressure was recorded at a cricoid force of 20 and 40 Newtons. Results Cricoid pressure decreased LES pressure from 24 +/- 3 mmHg to 15 +/- 4 mmHg at a force of 20 Newtons (P < 0.05) and to 12 +/- 4 mmHg with a force of 40 Newtons (P < 0.01). Conclusions These findings may explain the occurrence of pulmonary aspiration before tracheal intubation despite application of cricoid cartilage pressure.

A protocol implementation to determine aspiration risk in patients with multiple risk factors for gastroparesis

2021 ◽  
pp. 175045892199692
Author(s):  
Sarah Schwisow ◽  
Christian Falyar ◽  
Susan Silva ◽  
Virginia C Muckler
Keyword(s):  
Risk Factors ◽  
At Risk ◽  
Solid Food ◽  
Convenience Sample ◽  
Aspiration Risk ◽  
Physical Status Classification ◽  
Increased Risk ◽  
Gastric Contents ◽  
American Society ◽  
American Society Of Anesthesiologists

Patients with risk factors for gastroparesis are at increased risk for aspiration into the tracheobronchial tree. Current American Society of Anesthesiologists fasting guidelines use subjective measures to determine aspiration risk. A gastric ultrasound protocol can identify patients with risk factors for gastroparesis and determine the need to perform a point-of-care gastric ultrasound to objectively assess gastric antral contents. This enables the anaesthesia provider to assess patients at increased risk for aspiration. Additionally, many patients who present for surgery with risk factors for gastroparesis have an empty gastric antrum. Thus, the gastric ultrasound protocol checklist saves time and manpower requirements of anaesthesia staff without impacting patient safety or perioperative efficiency. A convenience sample of 40 patients consented for surgery was assessed using a screening tool to identify those at risk for gastroparesis and possible aspiration. Patients deemed at risk received a gastric ultrasound examination to evaluate for the presence of gastric contents. Over 12% of these patients had solid food gastric contents on exam. All patients with solid food gastric contents had an American Society of Anesthesiologists Physical Status Classification of 3 or higher, and two or more risk factors for gastroparesis.

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