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Analysis of anesthesia-related medical disputes in the 2009-2014 period using the Korean Society of Anesthesiologists database.

Roh WS, Kim DK, Jeon YH, Kim SH, Lee SC, Ko YK, Lee YC, Lee GH - J. Korean Med. Sci. (2015)

Bottom Line: Of these, the most common specific mechanism was hypoxia secondary to airway obstruction or respiratory depression (n=31).The sec most common damaging event was a 'cardiovascular events' (26/102, 25.5%), in which myocardial infarction was the most common specific mechanism (n=12).Our database analysis demonstrated several typical injury profiles (a lack of vigilance in seemingly safe procedures or sedation, non-compliance with the airway management guidelines, and the prevalence of myocardial infarction) and can be helpful to improve patient safety.

View Article: PubMed Central - PubMed

Affiliation: Department of Anesthesiology and Pain Medicine, School of Medicine, The Catholic University of Daegu, Daegu, Korea.

ABSTRACT
Using the Korean Society of Anesthesiologists database of anesthesia-related medical disputes (July 2009-June 2014), causative mechanisms and injury patterns were analyzed. In total, 105 cases were analyzed. Most patients were aged < 60 yr (82.9%) and were classified as American Society of Anesthesiologists physical status ≤ II (90.5%). In 42.9% of all cases, the injuries were determined to be 'avoidable' if the appropriate standard of care had been applied. Sedation was the sec most common type of anesthesia (37.1% of all cases), following by general anesthesia. Most sedation cases (27/39, 69.2%) showed a common lack of vigilance: no pre-procedural testing (82.1%), absence of anesthesia record (89.7%), and non-use of intra-procedural monitoring (15.4%). Most sedation (92.3%) was provided simultaneously by the non-anesthesiologists who performed the procedures. After the resulting injuries were grouped into four categories (temporary, permanent/minor, permanent/major, and death), their causative mechanisms were analyzed in cases with permanent injuries (n=20) and death (n=82). A 'respiratory events' was the leading causative mechanism (56/102, 54.9%). Of these, the most common specific mechanism was hypoxia secondary to airway obstruction or respiratory depression (n=31). The sec most common damaging event was a 'cardiovascular events' (26/102, 25.5%), in which myocardial infarction was the most common specific mechanism (n=12). Our database analysis demonstrated several typical injury profiles (a lack of vigilance in seemingly safe procedures or sedation, non-compliance with the airway management guidelines, and the prevalence of myocardial infarction) and can be helpful to improve patient safety.

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Analysis of the sedation cases (n = 39) by sedative drug used.
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Figure 1: Analysis of the sedation cases (n = 39) by sedative drug used.

Mentions: Analysis of cases according to anesthetic technique revealed that, with the exception of 4 cases, both general anesthesia and sedation cases resulted in grave complications (i.e., permanent/major injuries or death). However, in contrast to the general anesthesia cases, most sedation cases (27/39, 69.2%) showed deviations from the appropriate standard of care (i.e., were determined to be 'avoidable'). In sedation cases, no pre-procedural testing was performed at all in 32 of 39 patients (82.1%). Pre-anesthetic evaluation records and anesthesia records were absent in 92.3% and 89.7% of the sedation cases, respectively. A significant lack of vigilance during procedures was found in the sedation cases; six patients had virtually no monitoring, and 24 patients did not receive supplemental oxygen (Table 2). Most sedation (36/39, 92.3%) was provided simultaneously by the non-anesthesiologist(s) who performed the surgical/diagnostic procedure(s). Propofol-based regimens were used in the vast majority of sedation cases (35/39, 89.7%); propofol was used alone (n=20) or in combination with midazolam, ketamine, or remifentanil (n=15; Fig. 1).


Analysis of anesthesia-related medical disputes in the 2009-2014 period using the Korean Society of Anesthesiologists database.

Roh WS, Kim DK, Jeon YH, Kim SH, Lee SC, Ko YK, Lee YC, Lee GH - J. Korean Med. Sci. (2015)

Analysis of the sedation cases (n = 39) by sedative drug used.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4310949&req=5

Figure 1: Analysis of the sedation cases (n = 39) by sedative drug used.
Mentions: Analysis of cases according to anesthetic technique revealed that, with the exception of 4 cases, both general anesthesia and sedation cases resulted in grave complications (i.e., permanent/major injuries or death). However, in contrast to the general anesthesia cases, most sedation cases (27/39, 69.2%) showed deviations from the appropriate standard of care (i.e., were determined to be 'avoidable'). In sedation cases, no pre-procedural testing was performed at all in 32 of 39 patients (82.1%). Pre-anesthetic evaluation records and anesthesia records were absent in 92.3% and 89.7% of the sedation cases, respectively. A significant lack of vigilance during procedures was found in the sedation cases; six patients had virtually no monitoring, and 24 patients did not receive supplemental oxygen (Table 2). Most sedation (36/39, 92.3%) was provided simultaneously by the non-anesthesiologist(s) who performed the surgical/diagnostic procedure(s). Propofol-based regimens were used in the vast majority of sedation cases (35/39, 89.7%); propofol was used alone (n=20) or in combination with midazolam, ketamine, or remifentanil (n=15; Fig. 1).

Bottom Line: Of these, the most common specific mechanism was hypoxia secondary to airway obstruction or respiratory depression (n=31).The sec most common damaging event was a 'cardiovascular events' (26/102, 25.5%), in which myocardial infarction was the most common specific mechanism (n=12).Our database analysis demonstrated several typical injury profiles (a lack of vigilance in seemingly safe procedures or sedation, non-compliance with the airway management guidelines, and the prevalence of myocardial infarction) and can be helpful to improve patient safety.

View Article: PubMed Central - PubMed

Affiliation: Department of Anesthesiology and Pain Medicine, School of Medicine, The Catholic University of Daegu, Daegu, Korea.

ABSTRACT
Using the Korean Society of Anesthesiologists database of anesthesia-related medical disputes (July 2009-June 2014), causative mechanisms and injury patterns were analyzed. In total, 105 cases were analyzed. Most patients were aged < 60 yr (82.9%) and were classified as American Society of Anesthesiologists physical status ≤ II (90.5%). In 42.9% of all cases, the injuries were determined to be 'avoidable' if the appropriate standard of care had been applied. Sedation was the sec most common type of anesthesia (37.1% of all cases), following by general anesthesia. Most sedation cases (27/39, 69.2%) showed a common lack of vigilance: no pre-procedural testing (82.1%), absence of anesthesia record (89.7%), and non-use of intra-procedural monitoring (15.4%). Most sedation (92.3%) was provided simultaneously by the non-anesthesiologists who performed the procedures. After the resulting injuries were grouped into four categories (temporary, permanent/minor, permanent/major, and death), their causative mechanisms were analyzed in cases with permanent injuries (n=20) and death (n=82). A 'respiratory events' was the leading causative mechanism (56/102, 54.9%). Of these, the most common specific mechanism was hypoxia secondary to airway obstruction or respiratory depression (n=31). The sec most common damaging event was a 'cardiovascular events' (26/102, 25.5%), in which myocardial infarction was the most common specific mechanism (n=12). Our database analysis demonstrated several typical injury profiles (a lack of vigilance in seemingly safe procedures or sedation, non-compliance with the airway management guidelines, and the prevalence of myocardial infarction) and can be helpful to improve patient safety.

Show MeSH
Related in: MedlinePlus