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Injury and liability associated with monitored anesthesia care: a closed claims analysis

Sanjay M Bhananker1, Karen L Posner, Frederick W Cheney

  • 1Department of Anesthesiology, University of Washington, Virginia Mason Medical Center, Seattle, WA 98195, USA. sbhanank@u.washington.edu

Anesthesiology
|January 27, 2006
PubMed
Abstract

Insights

Monitored anesthesia care (MAC) injuries often result from oversedation and preventable fires. Improved monitoring and vigilance can significantly reduce patient harm during MAC procedures.

Area of Science:

  • Anesthesiology
  • Patient Safety
  • Medical Malpractice

Background:

  • Monitored anesthesia care (MAC) is increasingly utilized, necessitating an understanding of its associated risks.
  • Malpractice claims provide valuable insights into anesthesia-related injuries and liability.

Purpose of the Study:

  • To compare injury patterns and liability in monitored anesthesia care (MAC) versus general and regional anesthesia.
  • To identify specific mechanisms and preventability of adverse events during MAC.

Main Methods:

  • Analysis of closed malpractice claims from the American Society of Anesthesiologists Closed Claims Database since 1990.
  • Comparison of 121 MAC claims with 1,519 general and 312 regional anesthesia claims.
  • Detailed review of MAC claims to determine causative factors and liability.

Main Results:

  • MAC patients were older and sicker, often undergoing elective eye or facial plastic surgery.
  • Over 40% of MAC claims resulted in death or permanent brain damage, similar to general anesthesia.
  • Respiratory depression from oversedation (21%) and operating room fires (17%) were key injury mechanisms in MAC claims, often preventable with better monitoring and fire safety awareness.

Conclusions:

  • Oversedation causing respiratory depression is a significant cause of patient injury during MAC.
  • Enhanced monitoring, vigilance, and prompt resuscitation can prevent many MAC-related injuries.
  • Preventing operating room fires requires strict adherence to fire safety protocols, avoiding the "fire triad".

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