Analysis of Anesthesia-related Medical Disputes in the 2009-2014 Period Using the Korean Society of Anesthesiologists Database

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.

Practice guidelines for propofol sedation by non-anesthesiologists: the Korean Society of Anesthesiologists Task Force recommendations on propofol sedation

“…, benzodiazepines and/or opioids), propofol can easily lead to deep sedation or even general anesthesia requiring cardiopulmonary support. A series of reports by the Korean Society of Anesthesiologists (KSA) found that the number of disputed medical cases involving propofol sedation has increased in recent years, and the magnitude of injuries associated with propofol sedation is similar to those with general anesthesia [12]. Significant variation in propofol sedation practices was also found across different types of procedures, clinical specialties, and hospital classes.…”

Comparative Analysis of Anesthetic Legal Disputes between Older and Younger Patients Referred to the Korean Society of Anesthesiologists in 2009–2018

“…Our results regarding sedation-related problems are consistent with those of previous studies [13][14][15] showing that respiratory system events were the most common adverse events. Several studies 4,[13][14][15][16][17] have warned of the risk of respiratory depression associated with propofol overdose. The risk of propofol overdose is emphasized because the metabolic ability varies 19-fold among individuals; 18) thus, a lack of sufficient physician attention is related to a high risk of overdose.…”

“…The appropriateness of anesthesia was assessed by a reviewer who provided an expert consultation about the assigned cases using a numeric rating scale (NRS) from 1 to 9, in which 1 was the least appropriate and 9 was most appropriate in the process of anesthesia. On the basis of appropriateness, we estimated the preventability of the adverse event or outcome, 4) which was the possibility that a certain injury could have been prevented by appropriate treatment or precautions. NRS 1-3 included preventable events, that is, events that could easily have been prevented; NRS 4-6 included moderately preventable events, that is, events that might have been preventable; and NRS 7-9 included hardly preventable events, that is, events that were unlikely to have been prevented.…”

“…NRS 1-3 included preventable events, that is, events that could easily have been prevented; NRS 4-6 included moderately preventable events, that is, events that might have been preventable; and NRS 7-9 included hardly preventable events, that is, events that were unlikely to have been prevented. 4) The primary outcome was the percentage of preventable events. In addition, in the older patient group, we determined whether a preoperative frailty evaluation or comprehensive geriatric assessment had been carried out.…”

Survey of Anxiety in Ordinary Workers and Doctors Regarding Sedative Use during Endoscopic Examination in the Seoul Metropolitan Area

“…This result is attributed to frequent media coverage. In addition, 30 cases of deaths related to sedation made legal disputes in Korea between 2009 and 2014 12. Since ordinary workers also perceives adverse events to be occurring more often as compared to doctors, in order to lower the fear of adverse events a person receiving sedation could feel, there is a need for more detailed explanation about sedation.…”