Regional Anesthesia / Monitored Anesthesia Care

Journal Article

  1. 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
  2. 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.
  3. Metzner J, Posner KL, Lam MS, Domino KB. Closed claims analysis. Best Pract Res Clin Anaesthesiol. 25(2):263-76, 2011.  |  NLM PubMed Link  |  Subjects: Closed Claims Project Overview, Regional Anesthesia / Monitored Anesthesia Care, Respiratory System Damaging Events, Physiologic Monitoring, Quality of Care
    The profile of anesthesia liability changed over the decades, including the types of anesthesia care associated with claims as well as events and injuries leading to claims. The most common complications in 1990-2007 were death, nerve injury and permanent brain damage. The most common anesthesia-related events leading to claims were regional-block related, respiratory, cardiovascular and equipment-related. This review includes focus on liability related to the difficult airway, monitored anesthesia care, non-operating room locations, obstetric anesthesia, and chronic pain management.
  4. Lee LA, Posner KL, Kent CD, Domino KB. Complications Associated With Peripheral Nerve Blocks: Lessons From the ASA Closed Claims Project. Int Anesthesiol Clin. 49(3):56-67, 2011.  |  NLM PubMed Link  |  Subjects: Regional Anesthesia / Monitored Anesthesia Care, Nerve Injury
    Peripheral nerve block claims from 1990 or later in the acute pain and surgical setting were analyzed. Neuraxial blocks, eye blocks, and chronic pain blocks were excluded. Among 189 peripheral nerve block claims, the most common blocks were interscalene, axillary and intravenous regional anesthesia. There were no claims associated with newer techniques such as ultrasounded guided blocks, TAP/rectus sheath, or paravertebral blocks. There was one lumbar plexus/sciatic block and two claims associated with ilioinguinal blocks. Most peripheral nerve block claims were associated with temporary or non-disabling injuries. The most common complications were nerve injury (51%), death (11%), pneumothorax (6%), and brain damage (5%).
  5. Cheney FW. The American Society of Anesthesiologists closed claims project: the beginning. Anesthesiology 113(4):957-60, 2010.  |  NLM PubMed Link  |  Subjects: Closed Claims Project Overview, Regional Anesthesia / Monitored Anesthesia Care, Physiologic Monitoring
    This commentary in the Classic Papers Revisited section of Anesthesiology accompanies the reprinting of the first publication from the ASA Closed Claims Project: Unexpected cardiac arrest during spinal anesthesia: A closed claims analysis of predisposing factors by Robert A. Caplan, Richard J. Ward, Karen Posner, and Frederick W. Cheney (ANESTHESIOLOGY 1988; 68:5-11). The commentary provides the author's personal insights into the history of the ASA Closed Claims Project from its beginnings through 2010.
  6. Lee LA, Posner KL, Cheney FW, Caplan RA, Domino KB: Complications associated with eye blocks and peripheral nerve blocks: an American Society of Anesthesiologists closed claims analysis. Reg Anesth Pain Med 33(5):416-22, 2008.  |  NLM PubMed Link  |  Subjects: Regional Anesthesia / Monitored Anesthesia Care, Eye Injury
    Anesthesiologists who provided both the eye block and sedation for eye surgery (n = 59) had more injuries associated with block placement, a higher proportion of claims with permanent injury, and a higher proportion of claims with plaintiff payment, compared with anesthesiologists who provided sedation only (n = 38). Peripheral nerve blocks (n = 159) were primarily associated with temporary injuries (56%). Local anesthetic toxicity was associated with 7 of 19 claims with death or brain damage. Performance of eye blocks by anesthesiologists significantly alters their liability profile, primarily related to permanent eye damage from block needle trauma. Though most peripheral nerve block claims are associated with temporary injuries, local anesthetic toxicity is a major cause of death or brain damage in these claims.
  7. Bhananker SM, Posner KL, Cheney FW, Caplan RA, Lee LA, Domino KB. Injury and Liability Associated with Monitored Anesthesia Care: A Closed Claims Analysis. Anesthesiology 104(2):228-234, 2006.  |  NLM PubMed Link  |  Subjects: Regional Anesthesia / Monitored Anesthesia Care
    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.
  8. Lee LA, Posner KL, Domino KB, Caplan RA, Cheney FW. Injuries associated with regional anesthesia in the 1980s and 1990s: a closed claims analysis. Anesthesiology 101(1):143-152, 2004.  |  NLM PubMed Link  |  Subjects: Regional Anesthesia / Monitored Anesthesia Care
    Almost half of the regional anesthesia claims in the Closed Claims database from the 1980s and 1990s were block related, but the majority of obstetric claims are associated with temporary or low severity injury. Neuraxial cardiac arrest accounts for one third of high-severity injuries for obstetric and nonobstetric procedures, whereas neuraxial hematomas associated with coagulopathy result predominately from nonobstetric claims. Eye blocks have emerged as a new source of permanent injury in the 1990s.
  9. Caplan RA, Ward RJ, Posner K, Cheney FW: Unexpected cardiac arrest during spinal anesthesia: A closed claims analysis of predisposing factors. Anesthesiology 68:5-11, 1988.  |  NLM PubMed Link  |  Subjects: Regional Anesthesia / Monitored Anesthesia Care, Cardiovascular System Damaging Events
    This is an in-depth review of 14 cases of unexpected cardiac arrest in healthy patients which were identified in the first 900 claims reviewed in the ASA Closed Claims Project. A major factor in the poor outcome (six deaths, eight permanent brain damage).

Abstract

  1. Posner, K.L., Mincer S.L., Harvey A.E., Xue A.H., Van Norman G.A., Domino K.B.: Regional anesthesia decision aids in the pre-anesthesia clinic improve patient engagement and knowledge. Anesthesiology, A2211, 2015.  |  Subjects: Shared Decision-making/Informed Consent, Regional Anesthesia / Monitored Anesthesia Care, Quality of Care  |  PDF icon click here for pdf.pdf
  2. Posner, K.L., Van Norman, G.A., Mincer, S.L., Harvey, A.E., Domino, K.B.: Regional Anesthesia: Patients Want Information But Most Will Leave Anesthetic Choice To Their Doctors. Anesthesiology, A1216, 2014  |  Subjects: Shared Decision-making/Informed Consent, Regional Anesthesia / Monitored Anesthesia Care, Quality of Care  |  PDF icon Click here for.pdf
  3. Twersky R, Posner KL, Domino KB: Liability in Office-Based Anesthesia: Closed Claims Analysis. Anesthesiology, A2078, 2013  |  Subjects: Regional Anesthesia / Monitored Anesthesia Care, Quality of Care  |  PDF icon Click here for.pdf
  4. Lee L, Posner KL, Kent CD, Fitzgibbon D, Domino KB: Complications and Outcomes for Neuraxial Anesthesia for Surgery: A Closed Claims Analysis. Anesthesiology A415, 2011.  |  Subjects: Regional Anesthesia / Monitored Anesthesia Care  |  PDF icon Click here for .pdf
  5. Bhananker SM, Posner KL, Domino KB, Lee LA, Cheney FW: Liability Associated with Monitored Anesthesia Care: ASA Closed Claims Project. Anesthesiology, 99: A1356, 2003.  |  Subjects: Regional Anesthesia / Monitored Anesthesia Care  |  PDF icon Click here for .pdf
  6. Lee LA, Posner KL, Caplan RA, Domino KB, Cheney FW, ASA Closed Claims Project: An Analysis of Claims Associated with Regional Anesthesia in the Operative Setting 1980-1999. Anesthesiology 96: A1126, 2002.  |  Subjects: Regional Anesthesia / Monitored Anesthesia Care  |  PDF icon Click here for .pdf

Newsletter

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

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.