Malpractice In Monitored Anesthesia Care

Bob Carroll

Contributor

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Many of the serious risks of anesthesia extend to what is called Monitored Anesthesia Care (MAC) according to a recent medical journal article.

MAC is intended to provide a patient with anxiety relief, amnesia, pain relief, comfort, and safety during a procedure. MAC is often used by patients undergoing uncomfortable procedures and minor surgeries which do not require general anesthesia. The patient is sedated and amnestic but always remains responsive when stimulated to do so. The patient is essentially in a light sleep.

Injury and Liability Associated with Monitored Anesthesia Care: A Closed Claims Analysis Anesthesiology Volume 104, Number 2, February 2006

The ASA Closed Claims Project is a structured evaluation of adverse anesthetic outcomes obtained from the closed claim files of 35 US professional liability insurance companies.

Oversedation leading to respiratory depression was an important mechanism of patient injuries during MAC. Appropriate use of monitoring, vigilance, and early resuscitation could have prevented many of these injuries.

Nearly half of these claims were judged as preventable by better monitoring, including capnography, improved vigilance, or audible alarms.

Lack of vigilance contributed to damage in many of the events.

The implications of our closed claims review for the practice of anesthesia are that MAC providers need to be aware of the risk of serious respiratory depression when sedative-analgesic-hypnotic medications are used in combination, especially in elderly patients or those with systemic diseases. Continuous monitoring of ventilation and oxygenation, with audible alarms, and constant vigilance are mandatory.