Anesthesia Awareness

New Malpractice Concern: Waking in Surgery | Law.com | 11.15.04

The country’s top patient-safety watchdog group has issued an alert about the dangers of waking up during surgery — a warning that many in the legal and health professions say could trigger more malpractice suits against anesthesiologists.

Plaintiffs attorneys claim that in the past, people who awoke during operations rarely sued because they couldn’t prove it, and doctors ignored them.

But now, they say, these patients have new ammunition: an alert recently released by the Joint Commission on Accreditation of Healthcare Organizations. It says that anesthesia awareness happens 20,000 to 40,000 times a year, and that this phenomenon is an “under-recognized and under-treated” problem in the health care industry. …

“I think there’s a concern that this kind of an alert could prompt more lawsuits,” said Karen Posner, an anesthesiology professor at the University of Washington who tracks medical malpractice claims for the American Society of Anesthesiologists.

Courts have seen roughly a dozen anesthesia-awareness lawsuits in the last year, including cases in California, Utah, Alabama, Texas and Oklahoma, according to lawyers and the Reston, Va.-based nonprofit group Anesthesia Awareness. But they expect to see more given the new report, the increased publicity surrounding the issue and the recent availability of a new monitoring device that measures brain waves and tells when a person is regaining consciousness. While many patients want the device used, many doctors believe it is unreliable.

“It’s the patient’s word against the doctor’s,” said Hornsby. “And hospitals don’t admit a mistake was made, so defendants think they’re going crazy.”

But sometimes the patient’s memory can prove just as helpful. One of Hornsby’s clients — a woman who claimed she was awake while having her ovaries removed — helped prove her case when she recalled hearing the doctor take a phone call from his wife and from his daughter during her operation. In that case, the plaintiff won $150,000. Smith v. Riverside Hospital, No. L97-24745RF (Newport News, Va., Cir. Ct.).

“This is what I call invisible scars in the mind. The only injuries is what I call silent screams, the invisible tears,” Hornsby said.

Group targets anesthesia error | USA Today | 10.6.04

The nation’s leading patient-safety oversight group will call Wednesday for hospitals to do more to keep patients from “waking up” during surgery — a sometimes horrifying experience that medical experts believe happens 50 to 100 times each day.

The Joint Commission on Accreditation of Healthcare Organizations, which accredits hospitals and surgical centers that meet its safety criteria, said that while these events occur infrequently — between 0.1% and 0.2% of all surgeries — there is cause for alarm with 21 million operations performed each year.

The problem occurs when anesthesia wears off, and patients become aware of what is happening to them, but they are still paralyzed by drugs and unable to signal that they are awake. Depending on how alert the person becomes, the experience can range from simply hearing operating room conversations (48%), feeling like they can’t breathe (48%) or experiencing the pain of surgery (28%), according to a recent study in Anesthesia & Analgesia. …

“People in health care have been reluctant to talk about this, primarily because they were afraid of scaring patients,” O’Leary says. “You have to say honestly that this is a problem and we are going to do everything we can to make sure it doesn’t happen.” …

“The first thing is to draw attention to it,” O’Leary says. ” ‘This is a problem and we are working on it,’ is a very important message to the public.”

The Incidence of Awareness During Anesthesia: A Multicenter United States Study
Anesth Analg 2004 99: 833-839. September 2004.

Data from 19,575 patients indicate that the incidence of awareness with recall after surgery under general anesthesia is 0.13%. This means that the minimum incidence of awareness is 1.3 patients per 1000.

Bispectral index monitoring to prevent awareness during anaesthesia: the B-Aware randomised controlled trial
Lancet 2004; 363: 1757-63. May 29, 2004.

BIS-guided anaesthesia reduces the risk of awareness in at-risk adult surgical patients undergoing relaxant general anaesthesia. With a cost of routine BIS monitoring at US$16 per use in Australia and a number needed to treat of 138, the cost of preventing one case of awareness in high-risk patients is about $2200.

See JCAHO #1, #2, and #3

See Wikipedia

It is absolutely amazing to me that an article is published in September, JCAHO issues warnings in October, and come November there is a whole a new “field of malpractice” that trial lawyers are ready to plow. I can see bispectral index monitoring joining oximetry and capnography (here too) in my ER in the very near future—another standard of care coming…