Litigation related to inadequate anaesthesia: an analysis of claims against the NHS in England 1995–2007

Abstract

SummaryInadequate anaesthesia may cause distress to the patient and lead to medical litigation. All claims made to the NHS Litigation Authority 1995-2007 were obtained and the data was examined independently by all authors and classified. In a dataset of 1067 claims there were 161 cases of inadequate anaesthesia and data were suitable for analysis in 159: intra-operative awareness (79), brief awake paralysis (20) and inadequate regional anaesthesia (60). The total cost of closed claims was £3.2m. Cost was incurred in 100% of claims of brief awake paralysis, 87% of claims of awareness and 80% of claims of inadequate regional blockade. Mean cost of closed claims was £32 680 for anaesthetic awareness, £29 345 for inadequate regional blockade and £24 364 for brief awake paralysis. Inadequate anaesthesia accounts for 19% of anaesthesia-related claims in the NHS in England. Strategies that reduce anaesthetic awareness, drug errors and inadequate regional blockade are known and their improved implementation is likely to reduce such claims.

The 5th National Audit Project (NAP5) on accidental awareness during general anaesthesia: summary of main findings and risk factors

“…Certain types of surgery (e.g. cardiac, obstetric), female sex [21,22], higher ASA physical status [21,23,24] and obesity [25][26][27] are all implicated. The notion of an intrinsic, possibly genetic, resistance to anaesthesia has also been raised, with up to 11% of patients with AAGA having a previous history [8,27] and an important minority of AAGA cases having no apparent cause [9,28].…”

Litigation in obstetric general anaesthesia: an analysis of claims against the NHS in England 1995–2007

“…We have recently published several papers describing anaesthesia related claims against the National Health Service Litigation Authority (NHSLA) [1][2][3][4]. This letter serves to report, in brief, aspects of claims relating to obstetric general anaesthesia not reported in those papers and provides some comparison with obstetric regional anaesthesia claims [4].…”

“…Four fifths of obstetric general anaesthesia claims ( Table 1) described awareness during caesarean section; in contrast 21% of non-obstetric general anaesthesia claims described awareness [2] and 31% of obstetric regional anaesthesia claims described inadequate anaesthesia. The incidence of awareness in obstetric general anaesthesia has been reported as 0.26-0.4% [6][7][8], which extrapolates to approximately 40-60 UK cases over 10 years [9].…”

“…These figures were taken from the paper by Hawthorne et al [2] looking at the period 1984-1994 where this small apparent increase of about one case per year was not supported by statistical analysis. Moreover, the other paper referenced to support this claim in fact found no significant difference in the incidence of failed intubation over their 6-year study period [3].…”

“…Without this information it is impossible to compare Djabatey and Barclay's audit with others. Failed intubation can refer to the inability to intubate despite every effort or, as is often the case in failed intubation protocols, when it is not possible to intubate following a single dose of suxamethonium [2,6] or after a restricted number of attempts [7]. It is easy to see how earlier recognition of 'failure' will lead to an apparent increase in failed intubation rates.…”