- June 10, 2014
- By Dr Jock Mackenzie
- 0 comments
Clinical Negligence in Anaesthetics and Intensive Care
Anaesthetists specialise in anaesthetics, the branch of medicine that essentially involves putting you to sleep to enable you to undergo some form of intervention, whether that be a relatively minor investigative procedure or major surgery. Some anaesthetists specialise in managing acutely seriously ill patients on intensive care and others are experts in carrying out pain-relieving procedures and the management of chronic pain.
Anaesthesia is achieved by the administration of anaesthetic drugs, either general anaesthetics, which effectively make you lose consciousness, or local anaesthetics, when you remain awake during more minor procedures; anaesthesia includes the administration of sedatives (which make you drowsy and affect your memory), epidurals, spinals and nerve blocks. It is increasingly common for anaesthetists to sub-specialise in one of cardiac, thoracic, neuro, plastics, paediatrics, obstetrics or trauma and emergency anaesthesia.
Fortunately, it is very rare for things to go wrong with anaesthesia, but it does occasionally happen and, when it does, it is often catastrophic and may have profound consequences. If you or someone you know has suffered an adverse outcome following anaesthesia, possibly important or relevant things that you should consider include:
- Whether the anaesthetist carried out a full and proper pre-operative assessment, ensuring that all underlying or pre-existing medical problems and conditions (such as diabetes, etc.) and potential problems were considered and addressed prior to administration of the anaesthetic.
- Whether the induction process shortly prior to the anaesthesia was carried out appropriately, including whether appropriate drugs were used, whether they were administered appropriately and whether the endotracheal tube (ET tube) was correctly placed.
- The monitoring, observation and management during the anaesthesia, including whether proper monitoring was carried out, whether the ET tube dislodged during the operation, which can result in a lack of oxygen to the brain and subsequent brain damage, and whether any anaesthetics incidents were properly detected and managed. An example of what can go wrong is the seminal case relating to gross negligent manslaughter (R v Adomako) in 1994 involving the medical negligence of an anaesthetist who failed to notice for some 9 minutes that an anaesthetised patient’s endotracheal tube had become dislodged and consequently the patient suffered a cardiac arrest and died; the House of Lords considered that the breach of duty had been so terrible as to be considered ‘grossly negligent’ and, therefore, it warranted a criminal conviction for manslaughter.
- The management following surgery during the reversal of the anaesthetic and the recovery period, during which the anaesthetist must be vigilant to watch for involuntary biting on the ET tube, post-extubation laryngospasm (which is when the airway contracts after the ET tube has been removed, possibly causing hypoxia) or aspiration of gastric contents, which can ultimately result in Adult Respiratory Distress Syndrome (ARDS).
- If you underwent some form of local anaesthesia, whether the procedure was carried out technically appropriately, the correct drugs were used, proper monitoring was performed and whether you were adequately consented in relation to risks and complications.
Most anaesthetists are also usually experts in cardiopulmonary resuscitation, trained in advanced life support, and there is nearly always an anaesthetist involved as part of any hospital’s resuscitation (cardiac arrest) team to assist with the management of any patient who has suffered a cardiorespiratory arrest in hospital. It is possible that a patient may end up brain damaged as a consequence of inadequate resuscitation following a cardiorespiratory arrest.
Anaesthetists may perform regional anaesthetic injections and nerve blocks for fracture manipulation and pain relief, as well as epidurals in pregnancy and spinal injections. Complications can occur, such as damage to the spinal cord or injury to the regional nerves if these procedures are not carried out with sufficient care, and the effects can be significant, including paralysis of the area that the damaged nerve supplies.
Intensive care medicine is the area of medicine in which specialists (intensivists), often (but not always) anaesthetists, look after patients in an intensive care/therapy unit (ICU/ITU) or high dependency unit (HDU) setting rather than on a standard ward. In such settings, patients are usually very ill and require support for their vital organs, such as lungs, heart and kidneys, while ongoing very intensive monitoring. Mistakes can happen on intensive care, such as dislodging of the ET tube, but, because patients are usually very ill, which is of course why they are on ITU in the first place, it must be borne in mind that it can be difficult to establish that there was any negligence or, if there was, to prove that it made any difference to the eventual outcome.