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Intraoperative or Immediate Postoperative Death in ASA Class I Patient | Orange City Personal Injury Lawyer

Intraoperative or Immediate Postoperative Death in ASA Class I Patient

Intraoperative or immediate postoperative death in an American Society for Anesthesiologists Class 1 patient should never happen.

The Class 1 designation represents patients with the least amount of surgical risk and are the easiest to care for in the operating room. Still, a list of serious preventable ‘never events’ has been developed that includes a series of errors associated with the surgical care of inpatients and outpatients.

Medical Definition: The intraoperative or immediately postoperative death in an American Society for Anesthesiologists (ASA) Class 1 patient refers to the death during or after a surgery that is anesthesia related. The ASA classifies surgical patient risk based on their presenting history. ASA Class 1 patients present to the hospital or clinic for a minor surgical procedure. They have no chronic conditions, no issues with their airway, and no other identified conditions. These ASA Class 1 patients represent the least
amount of risk and are the easiest patients to care for in the operating room.

How often it occurs: The risk associated with complications and adverse events of anesthesia/anesthetics for surgical inpatients is 1 in 100,000.

During a 7-year study period from 1999 to 2005, there were a total of 2,211 anesthesia-related deaths in America, according to the Journal of the American Society of Anesthesiologists. Anesthesia complications were the underlying cause in 241 of these deaths (11 percent) and a contributing factor in the remaining 1,970 deaths (89 percent).

Almost 47 percent of the anesthesia-related deaths were due to overdose of anesthetics; followed by adverse effects of anesthetics in therapeutic use (42 percent); anesthesia complications during pregnancy, labor, and puerperium (4 percent); and other complications of anesthesia (7 percent).

Of the 241 deaths with anesthesia/anesthetics as the underlying cause of death, 80 percent resulted from adverse effects of anesthetics in therapeutic use; 19 percent resulted from anesthesia complications during pregnancy, labor, and puerperium; and 1 percent resulted from wrongly placed endotracheal tubes.

The number of anesthesia-related deaths averaged 315 deaths per year, including 34 deaths caused primarily by anesthesia/anesthetics. Males outnumbered females in anesthesia-related deaths by an 80 percent margin (1,428 vs.. 783). The majority (55 percent) of the decedents were aged 25–54 years old.

There were an estimated 105.7 million surgical discharges from U.S. hospitals during the study period. Of the 2,211 anesthesia-related deaths, 867 died in hospitals, 348 died in ambulatory care settings as outpatients, 46 died on arrival, 258 died at homes, 44 died in hospice facilities, 315 died at nursing homes or long-term care facilities, 327 died in other places, and for 6, the place of death was unknown. The estimated mortality risk from anesthesia complications for inpatients was 8.2 deaths per million hospital surgical discharges for men and 6.2 for women.

Why it occurs: According to the National Institutes of Health, the most common causes of anesthesia related deaths are: 1) circulatory failure due to decreased blood volume in combination with overdosage of anesthetic agents such as thiopentone, opioids, benzodiazepines or regional anesthesia; 2) hypoxia and hypoventilation after for instance undetected esophageal intubation, difficult intubation, technical failure in the anesthetic equipment, or aspiration of gastric content, 3) anaphylactoid reactions including malignant hyperthermia, and 4) human negligence such as lack of vigilance or errors in the administration of drugs and in the maintenance and control of the anesthetic equipment.

Patients who have pre-existing medical conditions such as heart disease, obesity, type 2 diabetes, high blood pressure and obstructive sleep apnea face increased risks during anesthesia, according to ASA.

The most effective way to understand and prepare for risks during anesthesia is to ask your physician about them before any medical procedure occurs. If you still have questions, talk to your anesthesia provider when he or she is introduced to you during pre-surgical care.

Because the risks are different for each patient, there is no single way to manage against anesthesia risk factors. For example, if you are a smoker and you’re scheduled for surgery, anesthesiologists recommend that you take steps right away to quit and remain smoke-free until at least one week after your procedure. Smokers have a greater chance of developing complications, including wound infections, pneumonia and heart attacks, both during and after surgery. The sooner you quit smoking before surgery, the better your chances are of avoiding complications.

Preventing Errors: When an intraoperative or immediately postoperative death occurs for an ASA Class 1 patient, it is considered a ‘never event.’ To prevent such deaths, the surgical team must know the patient’s history and possible risks during various portions of the intended procedure.

To help prevent surgical ‘never events’ like this, the Joint Commission on Accreditation of Healthcare Organizations published the Universal Protocol for Preventing Wrong Site, Wrong Procedure and Wrong Person Surgery. The Pennsylvania Patient Safety Authority organized the Universal Protocol into three different phases.

In phase one, the preoperative verification process, all the different documents and studies are reviewed, and preparations are made for the procedure.

In phase two, the protocol describes the proper marking of the operative site and who is responsible for this task. An “X” is not used to mark the operative site because it is ambiguous. Instead, initials are preferred (or the word “yes” can be used) for marking the site with an indelible marker.

In phase three, a “time out” is taken before starting the procedure so that the anesthesia team, surgeon, physician, and nursing staff can review the paperwork, evaluate the process, and verify that the patient, the equipment, and the operative site are all correct.

If this verification process is delayed until after the procedure, then someone on the team is not going to remember some item. Do not rely on a checklist. This step cannot be done by rote. This final step must be taken seriously and performed appropriately.

By following the Universal Protocol, fewer intraoperative or postoperative deaths should occur. Physicians, surgeons, and surgical staff members should take all possible precautions to prevent these deaths, both before and during the procedure.

For more on medical safety issues, see the library of articles by Daytona Beach medical malpractice attorney.


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