A clear and complete anesthesia record can provide evidence that a complication was recognized and appropriately treated.
ADVERSE ANESTHETIC OUTCOMES
During the 1990s, the top three causes for claims in the ASA Closed Claims Project were death (22%), nerve injury (18%), and brain damage (9%). In a 2009 report based on an analysis of NHS litigation records, anesthesia-related claims accounted for 2.5% of total claims filed and 2.4% of the value of all NHS claims. Moreover, regional and obstetrical anesthesia were responsible for 44% and 29%, respectively, of anesthesia-related claims filed.
The proportion of claims for brain injury or death was 56% in 1975 but decreased to 27% by 2000. The primary pathological mechanisms by which these outcomes occurred were related to cardiovascular or respiratory problems. The relative decrease in causes of death being attributed to respiratory rather cardiovascular damaging events during the review period was attributed to the increased use of pulse oximetry and capnometry.
Claims related to central venous access in the ASA database were associated with patient death 47% of the time and represented 1.7% of the 6,449 claims reviewed. Complications secondary to guidewire or catheter embolism, tamponade, bloodstream infections, carotid artery puncture, hemothorax, and pneumothorax all contributed to patient injury. Although guidewire and catheter embolisms typically were associated with less severe patient injuries, these complications were generally attributed to substandard care. Tamponade following line placement often led to a claim for patient death. The authors of a 2004 closed claims analysis recommended reviewing the chest radiograph following line placement and repositioning lines found in the heart or at an acute angle to reduce the likelihood of vascular perforation and tamponade. Claims related to peripheral vascular cannulation in the ASA database accounted for 2% of 6,849 claims, 91% of which were for complications secondary to the extravasation of fluids or drugs from peripheral intravenous catheters that resulted in extremity injury.
The decline in anesthesia-related maternal mortality may be secondary to the decreased use of general anesthesia in parturients, reduced doses of bupivacaine in epidurals, improved airway management protocols and devices, and greater use of incremental (rather than bolus) dosing of epidural catheters. Complications of neuraxial anesthesia (eg, postdural puncture headache) were most common, followed by systemic complications, including aspiration or cardiac events.
In the review of claims in which anesthesia was thought to have contributed to the adverse outcome, anesthesia delay, poor communication, and substandard care were thought to have resulted in poor newborn outcomes. Prolonged attempts to secure neuraxial blockade in the setting of emergency cesarean section can contribute to adverse fetal outcomes. Additionally, the closed claims review indicated that poor communication between the obstetrician and the anesthesiologist regarding the urgency of newborn delivery ...