The idea of a drug-induced coma or "artificial sleep" is never appealing to a person going under the knife, despite assurances from the anesthesiologist and surgeon. Now a new study, published in the Journal of Healthcare Risk Management, shows that while anesthesia-related deaths are on the decline, there is still a scope for risks which physicians and patients can reduce by taking certain precautions.

The study was based on 607 anesthesia-related claims reported by The Doctors Company, the nation's largest physician-owned medical malpractice insurer. The study titled "Analysis of Patient Injury Based on Anesthesiology Closed Claims Data from a Major Malpractice Insurer" was conducted by three prominent anesthesiologists from Harvard and Stanford and a patient safety expert with The Doctors Company.

The major findings were as follows:

  1. Almost 80 percent of anesthesia technical performance claims were based on complications that had been explained to patients prior to going under. So it can be inferred that patients who file claims despite this are unable to correlate their injuries to the information provided.
  2. Delayed response to flagging vital signs may have been a result of switching off or ignoring alarms.
  3. Tooth damage was a foremost injury in most claims.
  4. Obesity was shown to be the most significant patient characteristic in claims, since obesity significantly challenges anesthesia outcomes of patients compared to other conditions like diabetes or heart conditions.

"The results of this study show how important it is for physicians to communicate with patients about the outcomes of their care and to link informed consent discussions with the complication that they experienced," said co-author Richard D. Urman in a statement. Even though some patients may still be unsatisfied, they would better understand what caused their injury and would be “less likely to incorrectly ascribe the injury to substandard care," he added.

It's also the anesthesiologist's prerogative to get a complete understanding of the patient’s medical history. Conditions such as sleep apnea, seizure activity, allergies, reactions to anesthetics, comorbidities, etc. can and should be identified to prevent anesthesia-related complications.

Also, electrocardiograms and potassium levels should be evaluated before designing a suitable anesthesia plan. 

This research is an important guide for hospitals and doctors to promote patient safety, says coauthor Darrell Ranum. "For example, physician experts identified inadequate preoperative assessments in 15 percent of cases filed against anesthesia professionals. Knowledge of patient history, comorbidities, chronic conditions, and current status is essential for planning appropriate anesthetic treatment and is critical for anticipating complications that may arise during surgery,” he said.

Source: Ranum  D, Urman  R, Ma H, Shapiro  F, Chang  B. Analysis of Patient Injury Based on Anesthesiology Closed Claims Data from a Major Malpractice Insurer. Journal of Healthcare Risk Management. 2014.