Anesthesia injuries do not occur very often, but, when they do, they can be devastating.
There are two basic types of anesthesia, local and general. Local anesthesia is, as the name implies, delivered locally to the area of the intended surgery. While things can and do go wrong with local anesthesia, the damage is not usually catastrophic. General anesthesia is where things can go really wrong.
There are four main parts to general anesthesia: Sedation, analgesia, amnesia, and muscle paralysis. The anesthesiologist sedates the patient to relax him and to reduce anxiety. Analgesia is the reduction of the sensation of pain. Amnesia is the intended effect of keeping the patient from remembering what went on in the procedure. Muscle paralysis is to prevent the patient from moving.
In a major operative procedure, the patient will be intubated, which involves placing a tube called an endotracheal tube in the airway. This allows the anesthesiologist to control the airway and to deliver the anesthetic agents to the patient by mask.
The delivery of anesthetic agents to create unconsciousness and paralysis affects the cardiovascular system and the respiratory system. The patient can no longer breathe on their own. The anesthesiologist must control the delivery oxygen to the patient and also control the patient’s heart function and blood pressure. All of this requires careful monitoring of the patient’s vital signs during the procedure. When the procedure is complete, the anesthesiologist must wake the patient up and return her to her normal state.
Anesthesiologists must be able to both control what happens with the patient and to anticipate the patient’s reaction to what they are doing. If a patient begins to become unstable, the sooner the anesthesiologist recognizes it, the sooner she or he can begin to take corrective action.
Waking the patient up requires the anesthesiologist to begin to taper off the anesthetic agents as the procedure winds down and gradually awaken the patient. The endotracheal tube is withdrawn and the patient begins to breathe on their own again. A full return to consciousness does not happen quickly. The patient will spend some time in the Post-Anesthesia Care Unit, the PACU, before being either discharged or sent to a hospital floor.
One of the most common forms of anesthesia error involves a failure to properly monitor the patient. There are many ways in which this can occur. The anesthesiologist may be inattentive or may be distracted. The anesthesiologist may be slow to recognize the patient is destabilizing. There may be a poor hand off of the patient to the nurses in the PACU.
The failure to properly monitor the patient can lead to many complications. The heart rate may be allowed to get too slow or too fast. The heart may even stop. Even if the heart remains at a normal rate, the patient may not get enough oxygen. Our brains are the most oxygen sensitive part of our bodies. If the brain receives too little oxygen because the heart is beating too slowly or ineffectively or because there is not enough oxygen in the blood, permanent brain damage can occur and can occur in a very short period of time.
There are agents that can reverse the effects of some anesthesia. Anesthesiologists can get in trouble when using these agents at the end of a surgery to wake the patient up quickly. Both the reversal agent and the anesthetic agent have a fixed period of time in which they actively do their jobs. I was involved in a case in which the reversal agent woke the patient up and the patient appeared to be essentially fully recovered when the anesthesiologist left the patient with the nurses in the PACU. Unfortunately, anesthesiologist had not tapered off the paralyzing agent as the end of the surgery approached. Instead, he just gave a reversal agent to counteract the paralysis. After the patient arrived in the PACU, the reversal agent wore off before the anesthetic agent did and the patient, who had seemed fully recovered, began to experience the effect of the paralyzing agent again. The patient stopped breathing on his own and suffered catastrophic brain damage before anyone noticed he was not breathing.
Sometimes bad things can happen in surgery, even when everyone involved does their job perfectly. This, however, is very rare. Almost always when someone suffers a catastrophic injury during or after surgery, it is because someone didn’t do their job properly. If this happens to you or a loved one, talk to an experienced malpractice lawyer sooner rather than later. Don’t just assume that it was one of those things that is no one’s fault. Don’t accept the assurances of the doctors and nurses that this was no one’s fault. Let someone who knows what they are doing look into the facts for you. You and your loved one deserve a real answer.
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