Anesthesia

Sixty percent of the total indemnity paid to a group of patients who brought lawsuits against ophthalmologists for complications related to the management of cataract was for claims involving anesthesia. In this study, complications of anesthesia had the highest ratio of indemnification per claim of any category. An analysis of claims of eye injury associated with anesthesia showed 30% were characterized by patient movement during ophthalmic surgery. Blindness occurred in all these cases, most during general anesthesia, but in one of four cases, under monitored anesthesia. Complications from the administration of anesthesia for ophthalmic surgery are relatively uncommon; however, the losses from these claims are more expensive because the most severe injuries involve significant loss of vision, serious physical disability, or death.

Ophthalmologists traditionally administer topical and local (regional) anesthesia. An anesthesiologist or Certified Registered Nurse Anesthetist (CRNA) typically monitors regional anesthesia and administers general anesthesia. In many jurisdictions, regional blocks are given by anesthesiologists and CRNAs. This may create anxiety on the part of a patient unfamiliar with the person giving the anesthesia. In addition, a lawsuit arising from the actions of nonophthalmologic practitioners providing anesthesia to one’s patient may cause one to be sued for vicarious liability even though the practitioner is not in one’s employ. It is therefore imperative that the ophthalmic surgeon be familiar with the training, experience, and other pertinent credentials of personnel administering local anesthesia to his or her patients. Anyone giving anesthesia should pay meticulous attention to detail and be thoroughly familiar with ocular and orbital anatomy, physiology, and the pharmacology of the agents used.

while anesthesia problems involving litigation usually involve permanent injury to a patient, they are not necessarily the result of a deviation from the acceptable standard of care expected of an ordinary, well-qualified practitioner. Because patients do not anticipate difficulties from anesthesia, practically any problem may elicit investigation for possible litigation.