Anesthesia providers operate under a specialty-specific standard of care that reflects the unique physiological risks their interventions create. Under Georgia common law, an anesthesiologist, nurse anesthetist, or other anesthesia provider must exercise the degree of care and skill that a reasonably competent peer in the anesthesia specialty would apply under the same or similar clinical circumstances. The scope of this discussion is limited to errors arising from the anesthesia provider’s own clinical decisions and execution. Surgical technique errors by the operating surgeon and consent-related claims are distinct subjects addressed elsewhere.
Airway Management Errors
Airway management is the foundational competency of anesthesia practice. The anesthesia provider is responsible for establishing and maintaining a patent airway throughout the period of anesthesia, ensuring that the patient can receive adequate oxygenation and ventilation at all times. Airway management errors represent some of the most consequential failures in anesthesia care because the physiological margin for error is narrow: even a brief period of inadequate oxygenation can result in brain injury or death.
Airway errors can occur at multiple points in the anesthesia sequence. During induction, the provider may encounter difficulty securing the airway through intubation. The standard of care requires the provider to have assessed the patient’s airway anatomy in advance and to have a defined plan for managing anticipated or unanticipated difficulty, including the availability of alternative airway devices and a strategy for escalation when initial attempts fail. A provider who proceeds with induction without an adequate airway management plan, and who then cannot secure the airway, has potentially departed from the standard that a competent peer would follow.
During maintenance of anesthesia, the provider must ensure that the airway device remains properly positioned and functional. Displacement or obstruction of an endotracheal tube during a procedure can compromise ventilation without immediately obvious external signs if the provider is not monitoring the appropriate physiological indicators. The standard of care requires continuous vigilance over airway integrity throughout the anesthetic period.
Intraoperative Monitoring Failures
The anesthesia provider serves as the patient’s physiological guardian during surgery. While the surgeon’s attention is directed at the operative field, the anesthesia provider is responsible for continuously monitoring the patient’s cardiovascular, respiratory, neurological, and metabolic status. This monitoring function is not passive observation. It requires active interpretation of data streams and prompt response to changes that indicate physiological compromise.
Standard intraoperative monitoring includes continuous assessment of heart rate, blood pressure, oxygen saturation, end-tidal carbon dioxide levels, temperature, and, in many cases, depth of anesthesia. The standard of care requires not only that these parameters be monitored, but that the provider respond appropriately when values deviate from expected ranges. A monitoring failure can take the form of not observing a change that was displayed on the monitoring equipment, observing a change but failing to recognize its clinical significance, or recognizing the significance but failing to intervene in a timely manner.
The consequences of monitoring failures during anesthesia are amplified by the pharmacological context. The patient is unconscious, unable to report symptoms, and physiologically dependent on the anesthesia provider’s vigilance. A decline in oxygen saturation that would prompt a conscious patient to complain of shortness of breath produces no subjective signal during general anesthesia. The monitoring equipment is the patient’s voice, and the anesthesia provider’s attentiveness to that equipment is the mechanism through which physiological distress is detected and addressed.
Dosage Errors
Anesthetic agents are potent drugs with narrow therapeutic windows. The correct dose depends on multiple patient-specific variables, including body weight, age, hepatic and renal function, concurrent medications, and the specific demands of the surgical procedure. A dosage error occurs when the anesthesia provider administers an amount of anesthetic agent, analgesic, or paralytic that falls outside the range appropriate for the individual patient’s characteristics and clinical context.
Overdosing can produce cardiovascular depression, respiratory failure, prolonged unconsciousness, or, in severe cases, cardiac arrest. Underdosing can result in inadequate anesthesia depth during surgery, potentially leading to intraoperative awareness, a distressing event in which the patient regains some degree of consciousness during a procedure while paralytic agents prevent them from communicating or moving. Both categories of error reflect a failure in the dosing calculation, the administration process, or the ongoing titration of anesthetic depth during the procedure.
The standard of care requires the provider to calculate dosing based on the individual patient’s parameters, to verify the drug and concentration before administration, and to titrate the anesthetic throughout the procedure in response to the patient’s physiological feedback. A provider who applies a formulaic dose without accounting for patient-specific variables, or who fails to adjust dosing in response to clinical signs of inadequate or excessive anesthesia depth, may have departed from what a competent peer would do under the same circumstances.
Consider a scenario where an anesthesia provider encounters difficulty securing the patient’s airway during induction. The provider’s pre-anesthetic assessment had not identified the patient as a difficult-airway candidate, and no alternative airway devices were immediately available in the operating room. The delay in establishing a secure airway results in a period of inadequate oxygenation. The claim would allege that a competent anesthesia provider would have performed a thorough pre-anesthetic airway assessment, anticipated the potential for difficulty based on the patient’s anatomy, and ensured that alternative airway management equipment was available before initiating induction.
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