Abstract:
STUDY OBJECTIVE:To provide a contemporary medicolegal analysis of claims brought against anesthesia providers in the United States related to neuraxial blocks for surgery and obstetrics. DESIGN:In this retrospective analysis, we analyzed closed claims data from the Controlled Risk Insurance Company (CRICO) Comparative Benchmarking System (CBS) database between 2007 and 2016. SETTING:Closed claims from inpatient and outpatient settings related to neuraxial anesthesia for surgical procedures and obstetrics. PATIENTS:Forty-five claims were identified for analysis. These patients underwent a variety of surgical procedures, included both children and adults, and with ages ranging from 6 to 82. INTERVENTIONS:Patients receiving neuraxial anesthesia (spinals, epidurals) for surgery or obstetrics. MEASUREMENTS:Data collected includes patient demographics, alleged injury type/severity, surgical specialty, likely contributors to the alleged damaging event, and case outcome. Some of the data were drawn directly from coded variables in the CRICO database, and some were gathered from narrative case summaries. MAIN RESULTS:Settlement payments were made in 20% of claims. Reported adverse outcomes ranged from temporary minor to permanent major injuries. Most closed claims were classified as permanent minor injuries. The greatest number of claims involved residual weakness and radiculopathy resulting from epidurals. The largest contributing factor to these injuries was noted to be "Technical Knowledge/Performance" of the anesthesia provider followed by "Missing or Documentation Error." Over half of the claims arose from obstetric patients (31%) and patients undergoing orthopedic surgery (27%). CONCLUSIONS:Patients with pre-existing radiculopathy or comorbidities may warrant more thorough informed consent about the increased risk of injury. Additionally, prompt follow-up, monitoring, and documentation of post-operative symptoms, such as weakness or radiculopathy, are crucial for improving patient safety and satisfaction. More timely communication with the patient and the surgical team regarding residual neurologic symptoms is important for earlier diagnosis of injury.
journal_name
J Clin Anesthjournal_title
Journal of clinical anesthesiaauthors
Huang H,Yao D,Saba R,Brovman EY,Kang D,Greenberg P,Urman RDdoi
10.1016/j.jclinane.2019.03.013subject
Has Abstractpub_date
2019-11-01 00:00:00pages
66-71eissn
0952-8180issn
1873-4529pii
S0952-8180(19)30055-8journal_volume
57pub_type
杂志文章abstract:STUDY OBJECTIVE:Neuraxial blockade may increase external cephalic version (ECV) success rates. This survey aimed to assess the frequency and characteristics of neuraxial blockade used to facilitate ECV. SETTING AND DESIGN:We surveyed Society for Obstetric Anesthesia and Perinatology members regarding ECV practice usin...
journal_title:Journal of clinical anesthesia
pub_type: 杂志文章
doi:10.1016/j.jclinane.2016.05.040
更新日期:2016-11-01 00:00:00
abstract::Oxymetazoline nasal spray is a potent alpha 1-adrenergic agonist commonly used to vasoconstrict blood vessels in the nasal mucosa. In this incident, oxymetazoline nasal spray 0.025% was administered to a 2-year-old patient during general anesthesia for nasal endoscopy. Severe hypertension with reflex bradycardia progr...
journal_title:Journal of clinical anesthesia
pub_type: 杂志文章
doi:10.1016/0952-8180(95)00060-u
更新日期:1995-09-01 00:00:00
abstract::A case of unusual triple knotting of a central venous catheter inserted through the left basilic vein is reported. The catheter with intact triple knots could be withdrawn without an invasive maneuver. A possible cause of triple knotting was discussed in regard to the anatomic configuration of the central veins. This ...
journal_title:Journal of clinical anesthesia
pub_type: 杂志文章
doi:10.1016/0952-8180(89)90045-7
更新日期:1989-01-01 00:00:00
abstract:STUDY OBJECTIVES:To compare patients' perception of topical anesthesia (TA) with combined peribulbar and retrobulbar block (PRBB) for cataract surgery. DESIGN:Prospective, randomized, controlled, cross-over observational study. SETTING:Private clinic. PATIENTS:98 ASA physical status I and II patients presenting for ...
journal_title:Journal of clinical anesthesia
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1016/s0952-8180(00)00117-3
更新日期:2000-02-01 00:00:00
abstract:STUDY OBJECTIVE:To assess intubating conditions without neuromuscular blocking drugs, to determine the relation between the dose of rocuronium and the probability of achieving excellent or at least good (good or excellent) intubating conditions with the intubating laryngeal mask airway (ILMA), and finally, to determine...
journal_title:Journal of clinical anesthesia
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1016/j.jclinane.2004.06.009
更新日期:2005-05-01 00:00:00
abstract:STUDY OBJECTIVE:To investigate associations of heart rate variability (HRV) measurements with postoperative atrial fibrillation (AF) in patients undergoing off-pump coronary surgery. DESIGN:Prospective, observational, exploratory study. SETTING:Large university-affiliated community medical center. PATIENTS:50 patien...
journal_title:Journal of clinical anesthesia
pub_type: 杂志文章
doi:10.1016/j.jclinane.2010.12.016
更新日期:2011-09-01 00:00:00
abstract::A 21 year old healthy parturient was diagnosed as having a fetus with micrognathia. She was scheduled for an ex-utero intrapartum treatment (EXIT) procedure. General anesthesia consisted of remifentanil, nitrous oxide, and midazolam. Intravenous nitroglycerin was used for uterine relaxation. This technique offered hem...
journal_title:Journal of clinical anesthesia
pub_type: 杂志文章
doi:10.1016/j.jclinane.2009.12.014
更新日期:2011-03-01 00:00:00
abstract::Spinal epidural hematoma in the absence of coagulopathy or anticoagulation therapy is an extremely rare occurrence, with a reported incidence of less than 1 in 1 million. We present seven cases of documented epidural hematoma in the absence of coagulopathy or anticoagulation therapy to alert the clinician to consider ...
journal_title:Journal of clinical anesthesia
pub_type: 杂志文章
doi:10.1016/j.jclinane.2003.12.007
更新日期:2004-08-01 00:00:00
abstract:STUDY OBJECTIVE:To examine and compare the mechanism of injury, diagnostic findings, initial methods of airway management, and outcome of patients who had upper airway injuries. DESIGN:A retrospective review of hospital records. SETTING:A large metropolitan, university-affiliated trauma center. PATIENTS:Forty-six ca...
journal_title:Journal of clinical anesthesia
pub_type: 杂志文章
doi:10.1016/0952-8180(91)90003-6
更新日期:1991-03-01 00:00:00
abstract::With the advent of safety needles to prevent inadvertent needle sticks in the operating room (OR), a potentially new issue has arisen. These needles may result in coring, or the shaving off of fragments of the rubber stopper, when the needle is pierced through the rubber stopper of the medication vial. These fragments...
journal_title:Journal of clinical anesthesia
pub_type: 杂志文章
doi:10.1016/j.jclinane.2013.10.007
更新日期:2014-03-01 00:00:00
abstract::Visualization of thromboembolic material in the pulmonary artery is often difficult on transesophageal echocardiography, especially in the left pulmonary artery, because of the position of the left main bronchus. We present a case in which thromboembolic material within the midleft pulmonary artery was incidentally di...
journal_title:Journal of clinical anesthesia
pub_type: 杂志文章
doi:10.1016/j.jclinane.2007.06.026
更新日期:2008-03-01 00:00:00
abstract::Vagus nerve stimulation (VNS) for medically refractory seizures has been an approved therapy by the Food and Drug Administration since 1997, with additional approval as an adjunct therapy for major depression granted in 2005. Potential applications for VNS therapy in obesity, neuropsychiatric disorders, and chronic pa...
journal_title:Journal of clinical anesthesia
pub_type: 杂志文章,评审
doi:10.1016/j.jclinane.2009.10.002
更新日期:2010-05-01 00:00:00
abstract:STUDY OBJECTIVE:To ascertain the optimal dose of trimethaphan camsylate administered by intravenous (i.v.) bolus injection for the control of hypertension and tachycardia during electroconvulsive therapy (ECT). DESIGN:Prospective, double blind, within-subject study. SETTING:Treating room of the psychiatric unit of th...
journal_title:Journal of clinical anesthesia
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1016/0952-8180(95)00192-1
更新日期:1996-03-01 00:00:00
abstract:STUDY OBJECTIVE:To perform an analysis of the Medicare claims database in patients undergoing lung resection to determine whether there is an association between postoperative epidural analgesia and mortality. DESIGN:Retrospective cohort (database) design. SETTING:University hospital. MEASUREMENTS:We examined a coho...
journal_title:Journal of clinical anesthesia
pub_type: 杂志文章,随机对照试验
doi:10.1016/j.jclinane.2006.03.005
更新日期:2006-11-01 00:00:00
abstract:STUDY OBJECTIVES:To assess whether the year of residency in anesthesiology is associated with residents' overall perceptions of the learning environment and to evaluate the association between year of residency and each of the five domains of the Dundee Ready Education Environment Measure (DREEM) survey. DESIGN:Cross-...
journal_title:Journal of clinical anesthesia
pub_type: 杂志文章
doi:10.1016/j.jclinane.2016.09.017
更新日期:2016-12-01 00:00:00
abstract:STUDY OBJECTIVE:To compare the prophylactic administration of ondansetron with droperidol or placebo to determine its effectiveness in reducing postoperative nausea and vomiting after middle ear procedures. DESIGN:Prospective, randomized, double-blind study. SETTING:Inpatient otolaryngology service at a university me...
journal_title:Journal of clinical anesthesia
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1016/s0952-8180(97)00099-8
更新日期:1997-09-01 00:00:00
abstract:STUDY OBJECTIVE:To evaluate the cardiovascular changes following induction of anesthesia, laryngoscopy, and intubation in patients receiving a bolus dose of either eltanolone or propofol. DESIGN:Randomized, controlled, blind, prospective clinical study. SETTING:General operating theaters of a university hospital. PA...
journal_title:Journal of clinical anesthesia
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1016/0952-8180(94)00026-z
更新日期:1995-03-01 00:00:00
abstract::Obstructive sleep apnea (OSA) is associated with postoperative airway obstruction, hypoxemia, cardiac arrhythmias, cardiorespiratory arrest, hypoxic encephalopathy, and death. Three cases highlighting important issues in patients with OSA are presented that occurred prior to and after implementation of an OSA protocol...
journal_title:Journal of clinical anesthesia
pub_type: 杂志文章
doi:10.1016/j.jclinane.2008.08.023
更新日期:2009-06-01 00:00:00
abstract::Transurethral vaporization of the prostate is a new method of electrosurgery used for treating benign prostatic hypertrophy. We observed simultaneous obturator nerve stimulation during spinal anesthesia while the middle lobe of the prostate was being resected. A discussion of why electrovaporization is different from ...
journal_title:Journal of clinical anesthesia
pub_type: 杂志文章
doi:10.1016/s0952-8180(98)00069-5
更新日期:1998-09-01 00:00:00
abstract:BACKGROUND:Difficult intubation is a significant cause of mortality and morbidity related to anesthesia. We decided to evaluate the value of Modified Mallampati Score, Upper Lip Bite Test and Facial Angle in the prediction of difficult intubation. METHODS:In a prospective descriptive study, data from 132 patients who ...
journal_title:Journal of clinical anesthesia
pub_type: 杂志文章
doi:10.1016/j.jclinane.2016.12.010
更新日期:2017-02-01 00:00:00
abstract:BACKGROUND:Cardiac arrest is associated with very high mortality and causes neurological dysfunction in the survivors. Therapeutic hypothermia is one of the recommended modality in the postarrest management. However, recent findings question its benefit in postarrest management. This meta-analysis has been conceptualiz...
journal_title:Journal of clinical anesthesia
pub_type: 杂志文章,meta分析,评审
doi:10.1016/j.jclinane.2016.03.001
更新日期:2016-09-01 00:00:00
abstract:STUDY OBJECTIVE:Lambert-Eaton myasthenic syndrome (LEMS) is an autoimmune disorder of the neuromuscular junction that manifests with muscle weakness, autonomic and bulbar dysfunction, and increased sensitivity to neuromuscular blocking drugs. The objective of this study is to review perioperative outcomes on a series o...
journal_title:Journal of clinical anesthesia
pub_type: 杂志文章
doi:10.1016/j.jclinane.2014.09.009
更新日期:2014-12-01 00:00:00
abstract::The anesthetic management of a parturient with a circulating lupus anticoagulant and an anticardiolipin antibody presenting to the obstetric suite taking heparin and aspirin is discussed. Issues concerning placement of a regional anesthetic with recent aspirin ingestion and heparin therapy are discussed. Documentation...
journal_title:Journal of clinical anesthesia
pub_type: 杂志文章
doi:10.1016/0952-8180(95)00175-1
更新日期:1996-02-01 00:00:00
abstract::Informed consent is a cornerstone and routine component of the ethical practice of modern medicine. Its full theoretical application to specific clinical situations, however, presents a number of ethical dilemmas for health care providers. Obstetric anesthesia, in particular, presents many unique challenges to the pro...
journal_title:Journal of clinical anesthesia
pub_type: 杂志文章,评审
doi:10.1016/s0952-8180(02)00505-6
更新日期:2003-12-01 00:00:00
abstract:STUDY OBJECTIVE:To determine if practicing anesthesiologists recommend preoperative evaluations consistent with the 2007 ACC/AHA guidelines on perioperative care. DESIGN:Survey instrument. SETTING:Academic medical center. SUBJECTS:ASA membership. MEASUREMENTS:In this Web-based survey, participants were presented wi...
journal_title:Journal of clinical anesthesia
pub_type: 杂志文章,随机对照试验
doi:10.1016/j.jclinane.2011.11.007
更新日期:2012-09-01 00:00:00
abstract:STUDY OBJECTIVE:To evaluate the efficacy and safety profile of paracetamol in comparison with tramadol for pain relief during active labor. DESIGN:Prospective, randomized, double-blind study. SETTING:Maternity Wing of the Postgraduate Institute of Medical Education and Research, Chandigarh. PATIENT:Sixty laboring, p...
journal_title:Journal of clinical anesthesia
pub_type: 杂志文章,随机对照试验
doi:10.1016/j.jclinane.2014.08.008
更新日期:2015-03-01 00:00:00
abstract:STUDY OBJECTIVE:Physician-led multidisciplinary care coordination decreases hospital-associated care needs. We aimed to determine whether such care coordination can show benefits through the posthospital discharge period for elective hip surgery. DESIGN:Time Series of prospectively recorded and historical data. SETTI...
journal_title:Journal of clinical anesthesia
pub_type: 杂志文章
doi:10.1016/j.jclinane.2020.110072
更新日期:2021-02-01 00:00:00
abstract:STUDY OBJECTIVE:To measure the parameter of job satisfaction among anesthesiologists. DESIGN:Survey instrument. SETTING:Academic anesthesiology departments in the United States. SUBJECTS:320 anesthesiologists who attended the annual meeting of the ASA in 2009 (95% response rate). MEASUREMENTS AND MAIN RESULTS:The a...
journal_title:Journal of clinical anesthesia
pub_type: 杂志文章
doi:10.1016/j.jclinane.2013.01.007
更新日期:2013-06-01 00:00:00
abstract:STUDY OBJECTIVE:To report the occurrence of pseudo-hypotension during posterior osteotomy for correction of kyphosis in patients with ankylosing spondylitis. DESIGN:Retrospective case series. SETTING:University-affiliated hospital. MEASUREMENTS:The records of 36 patients with ankylosing spondylitis, who had severe t...
journal_title:Journal of clinical anesthesia
pub_type: 杂志文章
doi:10.1016/j.jclinane.2012.05.001
更新日期:2013-02-01 00:00:00
abstract:STUDY OBJECTIVE:To define the optimal dose of lidocaine to be added to propofol to reduce the incidence of pain during its injection. DESIGN:Double-blind, randomized, placebo-controlled study. SETTING:Medical center operating rooms. PATIENTS:135 ASA I and II female patients undergoing minor outpatient surgery. INTE...
journal_title:Journal of clinical anesthesia
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1016/s0952-8180(96)00133-x
更新日期:1996-11-01 00:00:00