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Regional Anesthesia / Monitored Anesthesia Care

Journal Article

  1. Caplan RA, Ward RJ, Posner K, Cheney FW: Unexpected cardiac arrest during spinal anesthesia: A closed claims analysis of predisposing factors. Anesthesiology 68:5-11, 1988. [Abstract, NLM PubMed Link] See also: Cardiovascular System
    1. This is an in-depth review of 14 cases of unexpected cardiac arrest in healthy patients which were identified in the first 900 claims reviewed in the ASA Closed Claims Project. A major factor in the poor outcome (six deaths, eight permanent brain damage) seemed to be inadequate appreciation of the need for early treatment of cardiac arrest with alpha agonists in order to counteract sympathetic blockade.
  2. Lee LA, Posner KL, Domino KB, Caplan RA, Cheney FW. Injuries associated with regional anesthesia in the 1980s and 1990s: a closed claims analysis. Anesthesiology. 2004 Jul;101(1):143-152. [Abstract, NLM PubMed Link] Order this article from: ASA Closed Claims Project
    1. Almost half of the regional anesthesia claims in the Closed Claims database from the 1980s and 1990s were block related, but the majority of obstetric claims are associated with temporary or low severity injury. Neuraxial cardiac arrest accounts for one third of high-severity injuries for obstetric and nonobstetric procedures, whereas neuraxial hematomas associated with coagulopathy result predominately from nonobstetric claims. Eye blocks have emerged as a new source of permanent injury in the 1990s.
  3. Bhananker SM, Posner KL, Cheney FW, Caplan RA, Lee LA, Domino KB. Injury and Liability Associated with Monitored Anesthesia Care: A Closed Claims Analysis. Anesthesiology. 2006 Feb;104(2):228-234. [NLM PubMed Link]
    1. Oversedation leading to respiratory depression was an important mechanism of patient injuries during MAC. Appropriate use of monitoring, vigilance, and early resuscitation could have prevented many of these injuries. Awareness and avoidance of the fire triad (oxidizer, fuel, and ignition source) is essential to prevent on-the-patient fires.
  4. Lee LA, Posner KL, Cheney FW, Caplan RA, Domino KB: Complications associated with eye blocks and peripheral nerve blocks: an American Society of Anesthesiologists closed claims analysis. Reg Anesth Pain Med 2008 Sep-Oct;33(5):416-22. [NLM PubMed Link]. See also: Injury - Eye.
    1. Anesthesiologists who provided both the eye block and sedation for eye surgery (n = 59) had more injuries associated with block placement, a higher proportion of claims with permanent injury, and a higher proportion of claims with plaintiff payment, compared with anesthesiologists who provided sedation only (n = 38). Peripheral nerve blocks (n = 159) were primarily associated with temporary injuries (56%). Local anesthetic toxicity was associated with 7 of 19 claims with death or brain damage. Performance of eye blocks by anesthesiologists significantly alters their liability profile, primarily related to permanent eye damage from block needle trauma. Though most peripheral nerve block claims are associated with temporary injuries, local anesthetic toxicity is a major cause of death or brain damage in these claims.
  5. Cheney FW. The American Society of Anesthesiologists closed claims project: the beginning. Anesthesiology. 2010 Oct;113(4):957-60. [NLM PubMed Link] See also: Monitoring - Physiologic, Project Overview.
    1. This commentary in the Classic Papers Revisited section of Anesthesiology accompanies the reprinting of the first publication from the ASA Closed Claims Project: Unexpected cardiac arrest during spinal anesthesia: A closed claims analysis of predisposing factors by Robert A. Caplan, Richard J. Ward, Karen Posner, and Frederick W. Cheney (ANESTHESIOLOGY 1988; 68:5–11, Abstract). The commentary provides the author’s personal insights into the history of the ASA Closed Claims Project from its beginnings through 2010.
  6. Metzner J, Posner KL, Lam MS, Domino KB. Closed claims analysis. Best Pract Res Clin Anaesthesiol. 2011 Jun;25(2):263-76. [NLM PubMed Link] See also: Monitoring - Physiology, Project Overview, Quality of Care, Respiratory.
    1. The profile of anesthesia liability changed over the decades, including the types of anesthesia care associated with claims as well as events and injuries leading to claims. The most common complications in 1990-2007 were death, nerve injury and permanent brain damage. The most common anesthesia-related events leading to claims were regional-block related, respiratory, cardiovascular and equipment-related. This review includes focus on liability related to the difficult airway, monitored anesthesia care, non-operating room locations, obstetric anesthesia, and chronic pain management.
  7. Lee LA, Posner KL, Kent CD, Domino KB. Complications Associated With Peripheral Nerve Blocks: Lessons From the ASA Closed Claims Project. Int Anesthesiol Clin. 49(3):56-67, 2011. [NLM PubMed Link] See also: Injury - Nerve.
    1. Peripheral nerve block claims from 1990 or later in the acute pain and surgical setting were analyzed. Neuraxial blocks, eye blocks, and chronic pain blocks were excluded. Among 189 peripheral nerve block claims, the most common blocks were interscalene, axillary and intravenous regional anesthesia. There were no claims associated with newer techniques such as ultrasounded guided blocks, TAP/rectus sheath, or paravertebral blocks. There was one lumbar plexus/sciatic block and two claims associated with ilioinguinal blocks. Most peripheral nerve block claims were associated with temporary or non-disabling injuries. The most common complications were nerve injury (51%), death (11%), pneumothorax (6%), and brain damage (5%).

ASA Newsletter

  1. Domino KB: Trends in anesthesia litigation in the 1990's: Monitored anesthesia care claims. ASA Newsletter 61(6):15-17, 1997. [Full Text] See also: Malpractice System; Monitoring - Physiologic

  1. Cheney, FW: High-Severity Injuries Associated with Regional Anesthesia in the 1990s. ASA Newsletter 65(6): 6-8, 2001. [Full Text; PDF Version]

  2. Domino, KB: Office-Based Anesthesia: Lessons Learned from the Closed Claims Project. ASA Newsletter 65(6): 9-11, 15, 2001. [Full Text; PDF Version]

Conference Presentations and ASA Abstracts

  1. Lee LA, Posner KL, Caplan RA, Domino KB, Cheney FW, ASA Closed Claims Project: An Analysis of Claims Associated with Regional Anesthesia in the Operative Setting 1980-1999. Anesthesiology 96: A1126, 2002. [Full Text]
  2. Bhananker SM, Posner KL, Domino KB, Lee LA, Cheney FW: Liability Associated with Monitored Anesthesia Care: ASA Closed Claims Project. Anesthesiology, 99: A1356, 2003. [Full Text]