Clinical and medicolegal aspects of conscious awareness during anesthesia

In summary, regarding the legal aspects of awareness during anesthesia, the questions for the court to answer are: Was the patient aware? If probably yes, did the anesthesia technique cause or materially contribute to the awareness? Alternatively, if res ipsa loquitur applies, can the anesthesiologist show that the technique was not negligent, if necessary by showing that it would have been acceptable to at least a responsible minority of practitioners? It will be clear from the foregoing that good recordkeeping cannot be overemphasized. Apart from the fact that a precise and clear record tends to convince the court that they are dealing with a careful practitioner, the most important factor is that the more you have recorded about the anesthesia course, the more you will be able to tell the court about it. Finally, if you are unfortunate enough to lose and the patient is awarded damages, how much will the patient get? In the United Kingdom recently, $20,000 was awarded to patients for awareness in orthopedic and obstetric cases--perhaps a modest amount by U.S. standards. If the patient develops posttraumatic stress disorder, a much larger award is likely, especially if the patient is unable to work as a result of it; loss of earnings always increases an award, and it could easily reach $750,000 for a big earner. Insurance or other indemnity should cover this, of course, but it pays to remember one's likely exposure to risk in the event of failing to pay one's premium.