1
|
Gupta A, Parida R, Subramaniam R, Kumar K. LMA gastro for gastro-intestinal endoscopic procedures: Pearls, pitfalls, and troubleshoots of its usage. Indian J Anaesth 2022; 66:S333-S336. [DOI: 10.4103/ija.ija_431_22] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 09/11/2022] [Accepted: 09/14/2022] [Indexed: 11/06/2022] Open
|
2
|
Current Trends and Predictors of Case Outcomes for Malpractice in Colonoscopy in the United States. J Clin Gastroenterol 2022; 56:49-54. [PMID: 33337638 DOI: 10.1097/mcg.0000000000001471] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 10/26/2020] [Indexed: 12/10/2022]
Abstract
BACKGROUND Over 14 million colonoscopies are performed annually, and this procedure remains the largest contributor to malpractice claims against gastroenterologists. The aim of this study was to evaluate reasons for litigation and predictors of case outcomes. MATERIALS AND METHODS Cases related to colonoscopy were reviewed within the Westlaw legal database. Patient demographics, reasons for litigation, case payouts, and verdicts were assessed. Multivariate regression was used to determine predictors of defendant verdicts. RESULTS A total of 305 cases were included from years 1980 to 2017. Average patient age was 54.9 years (range, 4 to 93) and 52.8% of patients were female. Juries returned defendant and plaintiff verdicts in 51.8% and 25.2% of cases, respectively, and median payout was $995,000. Top reasons for litigation included delay in treatment (65.9%) and diagnosis (65.6%), procedural error (44.3%), and failure to refer (25.6%). Gastroenterologists were defendants in 71% of cases, followed by primary care (32.2%) and surgeons (14.8%). Cases citing informed consent predicted defendant verdict (odds ratio, 4.05; 95% confidence interval, 1.90-9.45) while medication error predicted plaintiff verdict (odds ratio, 0.18; 95% confidence interval, 0.04-0.59). Delay in diagnosis (P=0.060) and failure to refer (P=0.074) trended toward plaintiff verdict but did not reach significance. Most represented states were New York (21.0%), California (13.4%), Pennsylvania (13.1%), Massachusetts (12.5%). CONCLUSIONS Malpractice related to colonoscopy remains a significant and has geographic variability. Errors related to sedation predicted plaintiff verdict and may represent a target to reduce litigation. Primary care physicians and surgeons were frequently cited codefendants, underscoring the significance of interdisciplinary care for colonoscopy.
Collapse
|
3
|
Du AL, Robbins K, Waterman RS, Urman RD, Gabriel RA. National trends in nonoperating room anesthesia: procedures, facilities, and patient characteristics. Curr Opin Anaesthesiol 2021; 34:464-469. [PMID: 34074883 DOI: 10.1097/aco.0000000000001022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Nonoperating room anesthesia (NORA) continues to increase in popularity and scope. This article reviews current and new trends in NORA, trends in anesthesia management in nonoperating room settings, and the evolving debates surrounding these trends. RECENT FINDINGS National data suggests that NORA cases will continue to rise relative to operating room (OR) anesthesia and there will continue to be a shift towards performing more interventional procedures outside of the OR. These trends have important implications for the safety of interventional procedures as they become increasingly more complex and patients continue to be older and more frail. In order for anesthesia providers and proceduralists to be prepared for this future, rigorous standards must be set for safe anesthetic care outside of the OR.Although the overall association between NORA and patient morbidity and mortality remains unclear, focused studies point toward trends specific to each non-OR procedure type. Given increasing patient and procedure complexity, anesthesiology teams may see a larger role in the interventional suite. However, the ideal setting and placement of anesthesia staff for interventional procedures remain controversial. Also, the impact of COVID-19 on the growth and utilization of non-OR anesthesia remains unclear, and it remains to be seen how the pandemic will influence the delivery of NORA procedures in postpandemic settings. SUMMARY NORA is a rapidly growing field of anesthesia. Continuing discussions of complication rates and mortality in different subspecialty areas will determine the need for anesthesia care and quality improvement efforts in each setting. As new noninvasive procedures are developed, new data will continue to shape debates surrounding anesthesia care outside of the operating room.
Collapse
Affiliation(s)
| | - Kimberly Robbins
- Department of Anesthesiology, University of California, San Diego, La Jolla, California, USA
| | - Ruth S Waterman
- Department of Anesthesiology, University of California, San Diego, La Jolla, California, USA
| | - Richard D Urman
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Rodney A Gabriel
- Department of Anesthesiology, University of California, San Diego, La Jolla, California, USA
- Department of Medicine, Division of Biomedical Informatics, University of California, San Diego, La Jolla, California, USA
| |
Collapse
|
4
|
Gastroscope-Facilitated Endotracheal Intubation During ERCP: When Is the Best Time to GETA (Big) MAC? Dig Dis Sci 2021; 66:938-940. [PMID: 32643057 DOI: 10.1007/s10620-020-06431-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
|
5
|
Is there a place for regional anesthesia in nonoperating room anesthesia? Curr Opin Anaesthesiol 2020; 33:561-565. [DOI: 10.1097/aco.0000000000000897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
6
|
Tran A, Thiruvenkatarajan V, Wahba M, Currie J, Rajbhoj A, van Wijk R, Teo E, Lorenzetti M, Ludbrook G. LMA® Gastro™ Airway for endoscopic retrograde cholangiopancreatography: a retrospective observational analysis. BMC Anesthesiol 2020; 20:113. [PMID: 32404136 PMCID: PMC7218825 DOI: 10.1186/s12871-020-01019-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Accepted: 04/22/2020] [Indexed: 12/27/2022] Open
Abstract
Background Various airway techniques have been employed for endoscopic procedures, with an aim to optimise patient outcomes by improving airway control and preventing hypoxia whilst avoiding the need for intubation. The LMA® Gastro™ Airway, a novel dual channel supraglottic airway technique, has been described as such a device. Its utility alongside sedation with low flow nasal cannula and general anaesthesia (GA) with intubation for endoscopic retrograde cholangiopancreatography (ERCP) procedures was evaluated. Methods Details of all the ERCPs performed in our institution from March 2017 to June 2018 were carefully recorded in the patients’ electronic case records. Data on the successful completion of ERCP through LMA® Gastro™ Airway; any difficulty encountered by the gastroenterologists; and adverse events were recorded. Episodes of hypoxia (SpO2 < 92%) and haemodynamic parameters were compared across the three groups: LMA® Gastro™ vs. sedation with low flow nasal cannula vs. GA with an endotracheal tube (ETT). Results One hundred seventy-seven ERCP procedures were performed during the study period. The LMA® Gastro™ Airway was employed in 64 procedures (36%) on 59 patients. Of these 64 procedures, ERCP was successfully completed with LMA® Gastro™ Airway in 63 (98%) instances, with only one case requiring conversion to an endotracheal tube. This instance followed difficulty in negotiating the endoscope through LMA® Gastro™ Airway. No episodes of hypoxia or hypercapnia were documented in both LMA® Gastro™ and GA with ETT groups. One sedation case with nasal cannula was noted to have hypoxia. Adverse intraoperative events were recognised in 2 cases of LMA® Gastro™: one had minimal blood stained secretions from the oral cavity that resolved with suctioning; the other developed mild laryngospasm which resolved spontaneously within a few minutes. Conclusion In patients undergoing ERCP, the LMA® Gastro™ airway demonstrated a high success rate for ERCP completion. Ventilation was well maintained with minimal intraoperative and postoperative adverse events. This technique may have a role in higher risk groups such as high ASA (American Society of Anesthesiologists) status, or those with potential airway difficulties such as high body mass index and those with known or suspected sleep apnoea.
Collapse
Affiliation(s)
- Andre Tran
- Discipline of Medicine, The University of Adelaide, Adelaide, South Australia, Australia
| | - Venkatesan Thiruvenkatarajan
- Department of Anaesthesia, The Queen Elizabeth Hospital, 28 Woodville Rd, Adelaide, South Australia, 5011, Australia.
| | - Medhat Wahba
- Department of Anaesthesia, The Queen Elizabeth Hospital, 28 Woodville Rd, Adelaide, South Australia, 5011, Australia
| | - John Currie
- Department of Anaesthesia, The Queen Elizabeth Hospital, 28 Woodville Rd, Adelaide, South Australia, 5011, Australia
| | - Anand Rajbhoj
- Department of Anaesthesia, The Queen Elizabeth Hospital, 28 Woodville Rd, Adelaide, South Australia, 5011, Australia
| | - Roelof van Wijk
- Department of Anaesthesia, The Queen Elizabeth Hospital, 28 Woodville Rd, Adelaide, South Australia, 5011, Australia
| | - Edward Teo
- Department of Gastroenterology, The Queen Elizabeth Hospital, 28 Woodville Rd, Adelaide, South Australia, Australia
| | - Mark Lorenzetti
- Department of Gastroenterology, The Queen Elizabeth Hospital, 28 Woodville Rd, Adelaide, South Australia, Australia
| | - Guy Ludbrook
- Discipline of Acute Care Medicine, The University of Adelaide, Adelaide, South Australia, Australia
| |
Collapse
|
7
|
What we can learn from nonoperating room anesthesia registries: analysis of clinical outcomes and closed claims data. Curr Opin Anaesthesiol 2020; 33:527-532. [DOI: 10.1097/aco.0000000000000844] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
8
|
Homsi JT, Brovman EY, Greenberg P, Urman RD. A closed claims analysis of vocal cord injuries related to endotracheal intubation between 2004 and 2015. J Clin Anesth 2019; 61:109687. [PMID: 31836265 DOI: 10.1016/j.jclinane.2019.109687] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 11/09/2019] [Accepted: 12/01/2019] [Indexed: 11/19/2022]
Abstract
STUDY OBJECTIVE To provide a contemporary medicolegal analysis of claims brought against anesthesiologists for injuries related to endotracheal intubation. DESIGN A retrospective study of closed claims data from the Controlled Risk Insurance Company (CRICO) Comparative Benchmarking System (CBS) database between 2004 and 2015. SETTING Closed claims that occurred in any surgical specialty in which the patient was undergoing general anesthesia and anesthesiology was named as the primary responsible service. PATIENTS Twenty claims were identified for analysis in 7 surgical specialties. Patient ages ranged from 45 to 76. Data regarding patient comorbidities and case history were obtained when available. INTERVENTIONS None. MEASUREMENTS Data collected includes patient demographics such as age, outcome severity, alleged complication, plaintiff allegations, contributing factors to the injury, the surgical specialty in which the injury occurred, and the ultimate result of the claim (dismissed/denied/settled). MAIN RESULTS Out of 20 claims, settlement payments were made in 10% of claims with a mean payment amount of $7669. Mean patient age was 55.6 years. Within severity of injuries, 65% of claims were classified as "Permanent Minor." The most common contributing factor in claims was "Technical Knowledge/Performance" and the most common plaintiff allegation was "Trauma from endotracheal tube placement." Bilateral vocal cord paralysis, unilateral (left-sided) vocal cord paralysis, and laryngeal nerve injury were the top alleged complications. The surgical specialty in which claims most often resulted was orthopedic surgery. CONCLUSIONS Injuries related to endotracheal intubation remain an ongoing challenge to anesthesiologists. Their etiology is often multifactorial and was found in this study to stem most commonly from technical errors and patient co-morbidities. A detailed discussion of risks with patients during the consent process, careful documentation of such discussion, and prompt referral to specialists when needed are critical. Understanding the patterns related to injuries during intubation is essential in order to develop strategies for improved patient safety and outcomes.
Collapse
Affiliation(s)
- Joseph T Homsi
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States of America.
| | - Ethan Y Brovman
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States of America; Center for Perioperative Research, Brigham and Women's Hospital, Boston, MA, United States of America; Department of Anesthesiology and Perioperative Medicine, Tufts Medical Center, Boston, MA, United States of America.
| | | | - Richard D Urman
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States of America; Center for Perioperative Research, Brigham and Women's Hospital, Boston, MA, United States of America.
| |
Collapse
|
9
|
Huang H, Yao D, Saba R, Brovman EY, Kang D, Greenberg P, Urman RD. A contemporary medicolegal claims analysis of injuries related to neuraxial anesthesia between 2007 and 2016. J Clin Anesth 2019; 57:66-71. [DOI: 10.1016/j.jclinane.2019.03.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2019] [Revised: 02/19/2019] [Accepted: 03/03/2019] [Indexed: 11/15/2022]
|
10
|
The Deep Sedation Conundrum and Paediatric Endoscopy. J Pediatr Gastroenterol Nutr 2019; 69:271-272. [PMID: 31211766 DOI: 10.1097/mpg.0000000000002419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
|
11
|
General endotracheal anesthesia for ERCP: Don't sleep on it! Gastrointest Endosc 2019; 89:863-864. [PMID: 30902207 DOI: 10.1016/j.gie.2018.10.044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 10/31/2018] [Indexed: 12/11/2022]
|
12
|
Aiello L, Corso RM, Bellantonio D, Maitan S. LMA Gastro Airway® Cuff Pilot for endoscopic retrograde cholangiopancreatography: a preliminary experience. Minerva Anestesiol 2019; 85:802-804. [PMID: 30871307 DOI: 10.23736/s0375-9393.19.13509-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Luca Aiello
- Unit of Intensive Care, Department of Surgery-Anaesthesia, GB Morgagni-L. Pierantoni Hospital, Forlì, Italy
| | - Ruggero M Corso
- Unit of Intensive Care, Department of Surgery-Anaesthesia, GB Morgagni-L. Pierantoni Hospital, Forlì, Italy -
| | - Daniele Bellantonio
- Unit of Intensive Care, Department of Surgery-Anaesthesia, GB Morgagni-L. Pierantoni Hospital, Forlì, Italy
| | - Stefano Maitan
- Unit of Intensive Care, Department of Surgery-Anaesthesia, GB Morgagni-L. Pierantoni Hospital, Forlì, Italy
| |
Collapse
|
13
|
Mora JC, Kaye AD, Romankowski ML, Delahoussaye PJ, Urman RD, Przkora R. Trends in Anesthesia-Related Liability and Lessons Learned. Adv Anesth 2018; 36:231-249. [PMID: 30414640 DOI: 10.1016/j.aan.2018.07.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- Juan C Mora
- Department of Anesthesiology, Division of Pain Medicine, University of Florida, PO Box 100254, Room 2036, Gainesville, FL 32610-0254, USA
| | - Alan D Kaye
- Department of Anesthesiology, Louisiana State University Health Sciences Center, Room 656, 1542 Tulane Avenue, New Orleans, LA 70112, USA
| | - Matthew L Romankowski
- Department of Anesthesiology, Division of Pain Medicine, University of Florida, PO Box 100254, Room 2036, Gainesville, FL 32610-0254, USA
| | - Paul J Delahoussaye
- Department of Anesthesiology, Louisiana State University Health Sciences Center, Room 659, 1542 Tulane Avenue, New Orleans, LA 70112, USA
| | - Richard D Urman
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA
| | - Rene Przkora
- Department of Anesthesiology, Division of Pain Medicine, Multidisciplinary Pain Medicine Fellowship, Anesthesiology Residency, University of Florida, PO Box 100254, Room 2036, Gainesville, FL 32610-0254, USA.
| |
Collapse
|
14
|
Kellner DB, Urman RD, Greenberg P, Brovman EY. Analysis of adverse outcomes in the post-anesthesia care unit based on anesthesia liability data. J Clin Anesth 2018; 50:48-56. [PMID: 29979999 DOI: 10.1016/j.jclinane.2018.06.038] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Revised: 06/13/2018] [Accepted: 06/15/2018] [Indexed: 11/25/2022]
Abstract
STUDY OBJECTIVE The aim of this study is to provide a contemporary medicolegal analysis of claims brought against anesthesiologists in the United States for events occurring in the post-anesthesia care unit (PACU). DESIGN In this retrospective analysis, we analyzed closed claims data from the Controlled Risk Insurance Company (CRICO) Comparative Benchmarking System (CBS) database. SETTING Claims closed between January 1, 2010 and December 31, 2014 were included for analysis if the alleged damaging event occurred in a PACU and anesthesiology was named as the primary responsible service. PATIENTS Forty-three claims were included for analysis. Data regarding ASA physical status and comorbidities were obtained, whenever available. Ages ranged from 18 to 94. Patients underwent a variety of surgical procedures. Severity of adverse outcomes ranged from temporary minor impairment to death. INTERVENTIONS Patients receiving care in the PACU. MEASUREMENTS Information gathered for this study includes patient demographic data, alleged injury type and severity, operating surgical specialty, contributing factors to the alleged damaging event, and case outcome. Some of these data were drawn directly from coded variables in the CRICO CBS database, and some were gathered by the authors from narrative case summaries. RESULTS Settlement payments were made in 48.8% of claims. A greater proportion of claims involving death resulted in payment compared to cases involving other types of injury (69% vs 37%, p = 0.04). Respiratory injuries (32.6% of cases), nerve injuries (16.3%), and airway injuries (11.6%) were common. Missed or delayed diagnoses in the PACU were cited as contributing factors in 56.3% of cases resulting in the death of a patient. Of all claims in this series, 48.8% involved orthopedic surgery. CONCLUSIONS The immediate post-operative period entails significant risk for serious complications, particularly respiratory injury and complications of airway management. Appropriate monitoring of patients by responsible providers in the PACU is crucial to timely diagnosis of potentially severe complications, as missed and delayed diagnoses were a factor in a number of the cases reviewed.
Collapse
Affiliation(s)
- Daniel B Kellner
- Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States of America.
| | - Richard D Urman
- Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States of America; Center for Perioperative Research, Brigham and Women's Hospital, Boston, MA, United States of America.
| | | | - Ethan Y Brovman
- Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States of America.
| |
Collapse
|