Anesthesia is the medical practice of sedating a patient to undergo a surgical or other invasive medical procedure. Anesthesia, from Greek for “without sensation,” is a controlled procedure where the anesthesiologist uses a combination of drugs to make the patient unconscious, provide relief from pain, and paralysis to immobilize the patient.
When the patient is anesthetized, they are generally not able to feel pain or remember the event. The anesthesiologist is supposed to closely monitor the patient to make sure their vital signs are stable. After the procedure is completed, the anesthesia wears off and the patient eventually recovers consciousness, which must also be closely monitored.
Anesthesia can be very safe but there is always a risk of complication. When the anesthesiologist or other health care professional fails to follow the standard protocols, makes a mistake or fails to properly monitor the patient, it can lead to serious injury or harm. Improper use of anesthetic drugs or a lack of oxygen to the brain can cause brain injury and death.
Anesthesia Procedures in Medical Care
Anesthesia can be used for both the benefit of the doctors and the patients. Without anesthesia, a patient may have tremendous pain and be unable to control their movement. When the patient is anesthetized, it can immobilize the patient so the surgeons can operate and relieve the patient of pain and awareness of the procedure until they emerge from the anesthesia. There are a few types of anesthesia, including localized anesthesia, regional anesthesia, sedation, and general anesthesia.
Sedation is generally used for pain control and to reduce anxiety. The patient is generally conscious and able to maintain an open airway and breathing, not requiring intubation. Also called conscious sedation or twilight sedation, the patient may or may not fall asleep.
Sedation is generally used in minor surgeries or short invasive procedures, where localized anesthetic would not be sufficient to reduce pain and discomfort. This can be used for certain types of biopsies, colonoscopy, throat/upper airway examination, or dental procedures
Sedation and analgesia (pain relief) are usually performed through introducing the medication through an IV into the bloodstream. The level of sedation can range from minimal to deep. With minimal sedation, you can generally interact with the doctor and follow instructions. With moderate sedation, you may fall asleep or feel drowsy. With deep sedation, you will likely sleep through the procedure and have little memory of what happened.
Local anesthesia generally involves a small area of the body where pain relief or numbing the area can allow for minor procedures, including skin biopsies, stitching, and dental procedures. Local anesthesia is generally performed through injecting anesthetic into a small area of the body. The patient usually feels pressure and may feel some pain but remains awake and conscious.
Regional anesthesia is similar to local anesthesia but they are generally for a larger part of the body. Regional anesthesia is often used for childbirth. Regional anesthesia numbs a larger part of the body, such as below the waist. Epidurals and spinal blocks are types of regional anesthesia. The patient is numbed in an area of their body but remains conscious.
General anesthesia is much more expansive than sedation or regional anesthesia. With general anesthesia, the central nervous system activity is suppressed. The patient is unconscious and unable to feel sensation while under the anesthesia. General anesthesia is usually used before any long or invasive surgical procedure, including anything from removal of wisdom teeth to heart bypass surgery.
General anesthesia may use inhaled or injected drugs, with the patient shortly after losing consciousness. The patient may then be intubated to keep the airway open and use a ventilator to maintain a steady oxygen supply to the heart and brain while the patient is unconscious.
General Anesthesia Procedure
General anesthesia has a multi-system effect, that includes temporary loss of consciousness, loss of memory, lack of sensation, and muscle relaxation. To complete these effects, a single or multiple drugs and medications may be used, including:
- Inhaled gases: (Sevoflurane, Desflurane, Isoflurane)
- IV drugs: (Propofol/Diprivan, Ketamine, Etomidate)
- Paralytics:(Succinylcholine, Vecuronium, Rocuronium, Cisatracurium)
The dosage of the general anesthetic drugs can range from inducing sleep to sedation that stops the patient's breathing.
After a patient receives the general anesthetic, the body reacts relatively quickly. There are 4 stages of anesthesia under the Guedel classification:
- Stage 1 - Analgesia or Disorientation: from beginning of receiving medication to loss of consciousness.
- Stage 2 - Excitement or Delirium: From loss of consciousness to onset of automatic breathing. During this stage, the patient may exhibit disinhibition, loss of eyelash reflex, uncontrolled movement, hypertension, and tachycardia. Other reflexes may remain intact and coughing, vomiting, and struggling may occur.
- Stage 3 – Surgical Anesthesia: from onset of automatic respiration to respiratory paralysis. There are 4 planes of surgical anesthesia, with Plane 3 referred to as “true surgical anesthesia,” as the ideal stage for surgery.
- Stage 4 - Overdose: from stoppage of respiration till death. Stage 4 is when too much anesthetic was given. Without cardiovascular and respiratory support, the patient in Stage 4 anesthesia can die. When a patient goes into Stage 4, the anesthesiologist should return the patient to Stage 3 as quickly as possible and maintain that level of anesthesia.
A number of other drugs may be used in conjunction with coming out of the anesthesia, or emergence. Pain and nausea are among the most common issues reported during and after emergence. Medical treatment often involves giving the patient anti-nausea medication and pain relievers.
During recovery, the patient needs to be closely monitored, with possible complications involving airway support, low blood pressure, and hypothermia. Patients often feel confused as they return to consciousness. This is more than just the anesthetic wearing off, it may also involve the brain navigating its way back to consciousness.
Anesthesia Use and Injury Statistics
From 2010 to 2014, there were more than 18 million anesthesia cases in the U.S. From 1999 to 2006, there were more than 2,200 anesthesia-related deaths in the U.S. The majority of those deaths were attributed to an overdose of anesthetics (46.6%), followed by adverse effects of anesthetics (42.5%). Other fatalities were attributed to complications of anesthesia in pregnancy and labor. The fatality rate was almost twice as high for men as for women.
According to the American Society of Anesthesiologists, more Americans are undergoing procedures involving anesthesia outside of the operating room (O.R.). Over a third of patients in the U.S. who undergo anesthesia are doing so for procedures that do not involve major surgery. Older patients and patients in poor health may be more likely to have minimally invasive procedures and tests done under anesthesia, with the most common procedure for non-O.R. procedure being a colonoscopy.
According to the Bureau of Labor Statistics (BLS), most anesthesiologists are employed in physicians' offices, hospitals, outpatient care centers, and specialty hospitals.
How Anesthesia Can Lead to Brain Injury
Improper use of anesthesia or failure to properly monitor a patient can lead to brain injury. Brain injury can be caused by an interaction with the specific drug or drugs used in anesthesia. Brain injury can also be caused by any complication that reduces the blood flow or oxygen supply to the brain.
When a patient is under the effects of anesthesia, complications may involve the underlying surgical procedure, the anesthesia, or a combination of the two. It is not always evident which was the cause of the complication or if both parts shared in the complication. It may take a close review by medical experts to identify whether a surgeon, anesthesiologist, or others were liable for injuries caused by negligence.
Anesthesia Drug Complications
Anesthesia drugs can affect different people in different ways. The impact of anesthesia on the body can depend on a number of factors, including patient's age, overall health, duration of anesthesia, and amount of drugs administered.
Allergic Reactions and Drug Interactions
Some antibiotics and muscle relaxants can elicit an allergic reaction to patients. Severe allergic reactions to drugs can include breathing difficulty, tachycardia, loss of consciousness, anaphylaxis, and shock.
Anesthesia in Children with Developing Brains
Anesthesia can have a different impact on children with still-developing brains. The level of oxygen provided to a child with anesthesia can also cause complications, including too low of levels of oxygen (hypoxia) or too much oxygen. Too high of oxygen levels may cause increased production of chemicals toxic to the lipids and proteins. Excess oxygen in premature babies can be related to eye injuries like retrolental fibroplasia.
Postoperative Cognitive Dysfunction
There is increasing awareness of the long-term effects of anesthesia in some patients. Postoperative cognitive dysfunction (POCD) is a decline in cognitive function that can last up to a year or longer after the surgery. Cognitive function in memory and behavioral control may be the most impacted. In some patients, POCD can last for several years, and is more common in older patients and those with other cognitive impairments. Long-term POCD may be associated with the body's inflammatory response to surgery.
Family members of a relative who has POCD report a lack of attention, memory loss, loss of interest in activities previously enjoyed. Some people report an inability to complete tasks at the same speed they could previously.
Although it is not associated with brain damage, a rare condition called anesthetic awareness can lead to mental distress. In anesthetic awareness, the patient can recall the events surrounding the surgery, including pressure, pain, and recall what was said and done at the time of the operation. Some of the lasting impacts can include posttraumatic stress disorder (PTSD), anxiety, nightmares, irritability, and depression.
Neurotoxicity of General Anesthetics
There are still questions about the effects of anesthetics on a number of tissues. Studies show evidence on the cytotoxic and neurotoxic properties of general anesthetics. According to one article, there is cause for concern and cause for continued research efforts in evaluating the long-lasting anesthetic-induced changes in the central nervous system.
Oxygen and Blood Flow Complications
Anesthesia can have a significant impact on the body's basic functions to maintain the cardiovascular system and brain function. This includes keeping an open airway, breathing, and heart function to provide blood and oxygen to the brain. Any reduction in blood or oxygen supply to the brain can cause serious damage, including permanent brain injury or death.
Brain injury can be caused when the patient is in Stage 4 of anesthesia. If the patient suffers hypoxic ischemia or anoxia while under anesthesia, any delay in returning cardiovascular and respiratory support can cause brain injury.
Damage to the brain from lack of oxygen can begin after as little as one minute and permanent damage can follow after a few minutes. Brain cells begin to die within minutes of oxygen deprivation. After about 10 minutes, brain damage can be extensive and the patient has a low chance of recovery.
Brain damage caused by anesthesia may be caused by administering too much anesthesia and failure to properly monitor the patient. Some cardiovascular complications may be caused by the surgery, the anesthesia, or a combination, where anesthesia is a contributing factor to brain injury.
Long-Term Effects of Anesthesia Brain Injury
The chance for recovery after anesthesia-related brain injury will depend on a number of factors, primarily the extent of the brain injury. For patients who recover some function after a brain injury, physical effects may include weakness, paralysis, or spasticity or rigidity disorders. Cognitive symptoms of a brain injury can include:
- Memory problems
- Problems with judgment and impulse control
- Difficulty recalling words
- Behaving sexually at inappropriate times
- Mood changes
- Impaired motor skills
- Dementia-like symptoms
Anesthesia Brain Injury Attorneys
Hospitals are not always open or forthcoming after a patient suffers a brain injury, falls into a coma, or dies during surgery. The doctors may not give a straight answer about what caused the injury and if the surgeon or anesthesiologist may have made a mistake. Unfortunately, for the family of a brain injury victim, it may take a medical malpractice lawsuit before the hospital takes their concerns seriously.
If a loved one died or suffered a brain injury as the result of anesthesia errors, failure to monitor the patient, or other anesthesia complications, talk to an experienced medical malpractice attorney about holding the doctors and hospital accountable for their failures. Do not hesitate to contact Gilman & Bedigian today for a free consultation.