Anesthesia injury can come in a number of forms.
When stomach contents enter the airway there is trouble. This happens.
The use of anesthesia on a full stomach causes this. Anesthesia injury arises from stomach contents entering the airway. It is avoidable. The patient’s stomach contents enter into the tube that carries food from the stomach. From the food tube the contents enter the airway and this food then goes into the lower airway. From there it goes into the lungs. The acid nature of this food burns within the lung tissue. This is harmful.
Because of this risk there is an eight hour rule that is used by doctors. The patient should not have any food or liquids within eight hours. After eight hours without food or liquids the stomach has emptied. Anesthesia can then be used safely.
Within the digestive system there is a gag reflex. That gag reflex protects the airway. As part of that gag reflex there is also a cough reflex. This expels matter that is trying to or has partly entered the airway. Anesthesia makes the gag reflex and the cough reflex go to sleep. Right after these reflexes go to sleep they are then aroused by the anesthesia. This means that there may be gagging or coughing after the anesthesia is given. This is why there must not be contents in the stomach when anesthesia is given.
In some cases the anesthesiologist assumes that the stomach is not empty. An example is in dealing with a trauma patient. There the patient cannot state when they last ate food or liquid. It must be assumed they do have food and/or liquid in their stomach. Therefore other options are used to deal with that while still using anesthesia.
In those cases where the doctor believes the patient has not consumed food or liquids within eight hours there are still other factors to look at. These must be looked at before deciding that the eight hour rule in fact applies:
Spinal cord anesthesia is used during certain types of surgery. For instance it is used during childbirth. The drug is injected into the epidural space. There is cerebral spinal fluid (CSF) in these spaces. The CSF that is in these spaces is the same as the CSF that is in the brain. This is why a CSF analysis from a spinal tap gives info not only about the brain but also about the spinal cord.
The injection of a drug into these spaces is dangerous. If the drug rises too high in the spine it halts breathing. The movement of the drug is controlled by controlling the movement of the patient. The head up or down governs which way the drug flows. Today the use of spinal anesthesia is not as common as it used to be because of this danger and the risk of withdrawing CSF fluid from the patient.
Brain function monitoring can prevent anesthesia injury. Failure to monitor may be medical malpractice. Brain function monitoring is the key to the use of the proper amount of drugs in general anesthesia.
The brain function monitor is a fairly simple device. This fairly cheap sensor is placed on the forehead of the patient and plugs into a computer. It gives a number between 0 and 100 that measures the response of each patient to the drug. The doctor then knows exactly how much drug needs to be given. It has been the practice to use 20% to 30% more anesthesia than is necessary in order to be on the safe side. Too much however can result in death, mental impairment or brain damage. Too little results in the patient waking up during the course of the surgery.
The use of anesthesia is local, regional or general. Local effects only a small part of the body. Regional is a nerve block that blocks a bundle of nerves. General anesthesia results in unconsciousness and absence of pain and loss of memory.
The doctor measures whether the goals are being met by observing the vital signs. Those are the level of oxygen in the blood and gases, breathing, blood pressure, heart rate and temperature.
A brain function monitor removes the guess work in deciding whether or not the goal is being achieved. It provides a great deal of precision to the doctor as to how much the patient needs to achieve these goals.
If you have have a claim as a result of the use of too much anesthesia, contact us.
Likewise if you have a claim as a result of gastric aspiration during the use of anesthesia, contact us.
Another form of injury is postoperative visual loss (POVL). The most common cause of POVL is a decrease in blood and oxygen getting to the optic nerve which provides sight. The duty to provide this proper circulation rests with the anesthesiologist and the failure to provide that may be medical malpractice.
Oxygen moves from the lungs to the rest of body by means of blood. It is the hemoglobin in the red blood cells that transmits the oxygen. The level of oxygen in the blood is governed by the percent of red blood cells present in the blood stream. This is called the hematocrit. When a patient loses blood during the course of surgery sometimes non-blood products are used to maintain the patient’s blood pressure. This dilution of the blood results in the hematocrit going down. As a result this reduces the blood’s ability to carry oxygen.
In those cases where a patient has POVL the primary factor to be looked for is whether or not the patient went through a surgery in the prone position that lasted six hours or more with blood loss of at least one liter. The issues of hematocrit level, dilution of the blood, blood and tissue pressure during the course of the surgery and patient position all have an effect. They impact the the heart being able to pump enough blood and oxygen to that area of the optic nerve. If that does not occur, then the patient may suffer POVL.
During many procedures the patient’s head is below the level of the heart for a long time to facilitate access. Tissue pressure from swelling during the course of the procedure can make it more difficult for the heart to pump blood to the head which is where the optic nerves are. This alone can cause injury
A March 2011 article of the New England Journal of Medicine reports anesthesia in children as having some link with brain cell death and writing problems in young children. The article certainly raises some red flags that both practitioners and parents need to be aware of.
Studies in rats and monkeys reveal that use of anesthesia in those very young animals, corresponding with children under age 4, is linked to brain cell death. The National Center for Toxicology Research of the Food and Drug Administration found that exposing five day old monkeys to 24 hours of anesthesia resulted in decreased performance in memory tests and other tests involving attention and learning.
No firm conclusions arise at this point and further study is underway. Where a child may need two small procedures each involving anesthetics then it may make sense to try to combine the two in one day so as to reduce the overall risk.