General Anesthesia

Journal Article

  1. Mehta SP, Eisenkraft JB, Posner KL, Domino KB. Patient Injury From Gas Delivery Equipment: A Closed Claims Update. Anesthesiology 119(4): 778-795, 2013  |  NLM PubMed Link  |  Subjects: General Anesthesia, Equipment Problems as Damaging Events
    This article reviews the incidence, causes, and severity of patient injuries from anesthesia gas delivery equipment using the Closed Claims Project database from the 1970’s to the 2000’s. Over the decades, claims associated with anesthesia gas delivery equipment decreased in number and severity, with a higher proportion of awareness and pneumothorax in recent claims. These decreases are associated with advances in training and improved equipment/machine design. Eighty-five percent of recent claims were due to human error. Examples of errors were inadequate use of alarms, improvised oxygen delivery systems, and failure to initiate manual ventilation. A third of recent claims were judged preventable by preanesthesia machine check.
  2. Chui J, Murkin JM, Posner KL, Domino KB. Perioperative Peripheral Nerve Injury After General Anesthesia: A Qualitative Systematic Review. Anesth Analg 2018;127:134-43  |  NLM PubMed Link  |  Subjects: Ambulatory, Offices, and Remote Locations, Professional Liability Related, General Anesthesia, Nerve Injury, Physiologic Monitoring, Quality of Care
  3. Honardar MR, Posner KL, Domino K.B. Delayed Detection of Esophageal Intubation in Anesthesia Malpractice Claims: Brief Report of a Case Series. Anesth Analg 2017;125(6):1948-51  |  NLM PubMed Link  |  Subjects: Ambulatory, Offices, and Remote Locations, General Anesthesia, Respiratory System Damaging Events, Physiologic Monitoring, Quality of Care
  4. Kent CD, Stephens LS, Posner KL, Domino KB. What Adverse Events and Injuries Are Cited in Anesthesia Malpractice Claims for Nonspine Orthopaedic Surgery? Clin Orthop Relat Res 2017;doi:10.1007/s11999-017-5303-z  |  NLM PubMed Link  |  Subjects: General Anesthesia, Regional Anesthesia / Monitored Anesthesia Care, Nerve Injury, Quality of Care
  5. Kent CD, Posner KL, Mashour GA, Mincer SL, Bruchas RR, Harvey AE, Domino KB. Patient perspectives on intraoperative awareness with explicit recall: report from a North American anaesthesia awareness registry. British Journal of Anaesthesia 2015 115 (suppl 1): i114-i121 doi: 10.1093/bja/aev211  |  NLM PubMed Link  |  Subjects: Awareness, General Anesthesia, Quality of Care
    This article, using a patient centered approach, characterizes anesthesia awareness events based on the patient’s experiences, and provides their recommendations for health care provider responses to this continuing problem. The authors reviewed self-reported incidences of recall during general anesthesia from the Anesthesia Awareness Registry. Seventy-five percent of patients were dissatisfied with the way their concerns were handled by health care providers. Problems identified by patients included lack of concern, lack of an apology, and no referrals to follow-up counselling. Patients expressed they wanted validation of their experience, explanations, and increased discussion and follow-up. Anesthesia awareness has serious impacts on some patients and more systematic responses and follow-up are needed.
  6. Mehta SP, Bhananker SM, Posner, KL, Domino KB. Operating Room Fires: A Closed Claims Analysis. Anesthesiology 2013 May; 118(5):1133-1139  |  NLM PubMed Link  |  Subjects: General Anesthesia, Regional Anesthesia / Monitored Anesthesia Care, Equipment Problems as Damaging Events, Burns
    This study used the ASA Closed Claims Project database to assess patterns of injury and liability associated with operating room (OR) fires. Files from 1985 to 2009 were reviewed for this study. OR fires were an increasing source of injury to patients and liability for anesthesiologists. Electrocautery procedures in the presence of supplemental oxygen, especially by open delivery systems, during MAC were predominant mechanisms for OR fires. Continuing education and communication along with fire prevention protocols are crucial components to reducing the occurrence of OR fires.
  7. Kent CD, Domino KB. Awareness: practice, standards, and the law. Best Pract Res Clin Anaesthesiol. 21(3):369-83, 2007.  |  NLM PubMed Link  |  Subjects: Awareness, General Anesthesia
  8. Domino KB, Posner KL, Caplan RA, Cheney FW: Awareness during anesthesia: A closed claims analysis. Anesthesiology 90: 1053-1061, 1999.  |  NLM PubMed Link  |  Subjects: Awareness, General Anesthesia
    Deficiencies of labeling and vigilance were common causes for awake paralysis, whereas recall during general anesthesia represented a more diverse group. Claims for recall during general anesthesia were more likely in females and with nitrous-narcotic-relaxant techniques.
  9. Caplan RA, Vistica MF, Posner KL, Cheney FW: Adverse anesthetic outcomes arising from gas delivery equipment: A closed claims analysis. Anesthesiology 87: 741-8, 1997.  |  NLM PubMed Link  |  Subjects: General Anesthesia, Equipment Problems as Damaging Events
    Problems with equipment used in anesthesia gas delivery systems accounted for 72 (2%) of 3,791 claims in the database. The specific devices involved in these claims were the anesthesia machine, breathing circuit, supplemental oxygen delivery tubing, supply tanks or lines, vaporizors and ventilators. Misuse of equipment was more common than equipment failure, and most of these equipment problems (76%) resulted in death or brain damage. Claims associated with gas delivery equipment are infrequent but sever and continue to occur in the 1990's.

Abstract

  1. Honardar, M.R., Posner, K.L., Domino, K.B.: Delayed detection of esophageal intubation in anesthesia malpractice claims. Anesthesiology, BOC03, 2016.  |  Subjects: Professional Liability Related, General Anesthesia, Respiratory System Damaging Events, Physiologic Monitoring, Quality of Care  |  PDF icon Click here for pdf.pdf
  2. Kutteruf, R.E., Stephens, L., Posner, K.L., Domino, K.B., Wells, D., Lee, L.: Injury and liability associated with spine surgery. Anesthesiology, A2159, 2015.  |  Subjects: Hemorrhage, Postoperative Visual Loss, Professional Liability Related, General Anesthesia, Eye Injury, Nerve Injury, Quality of Care  |  PDF icon click here for pdf.pdf
  3. Mehta SP, Posner KL, Domino KB. Patient Injuries From Anesthesia Gas Delivery Equipment: A Closed Claims Update. Anesthesiology, A1072, 2012.  |  Subjects: General Anesthesia, Equipment Problems as Damaging Events  |  PDF icon mehta_gasdelivery_A1072.pdf
  4. Kent CD, Posner KL, Cheney FW, Lee LA, Domino KB: Update on Closed Claims for Awareness during General Anesthesia. Anesthesiology 105: A1548, 2006.  |  Subjects: Awareness, General Anesthesia  |  PDF icon Click here for .pdf

Video/Multimedia

  1. On Patient Fires: Prevention during monitored anesthesia care (Educational Video)  |  Subjects: General Anesthesia, Regional Anesthesia / Monitored Anesthesia Care, Equipment Problems as Damaging Events, Burns  |  Full Text

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Closed Claims Bibliography

To access a complete bibliography of peer-reviewed journal articles from the Closed Claims Project, click here; Closed Claims Project Bibliography . You may also request delivery of the bibliography via e-mail, fax or postal mail.

Note to Patients

These studies are primarily designed to aid physicians in improving their clinical practice. We are sorry we cannot address individual patient questions or give medical or legal advice or provide data analysis.