Anesthesia Student Survival Guide.pdf - Index of

ethicAl And leGAl issues in AnesthesiA ● 501
If you proceed with surgery with general endotracheal anesthesia, and you are
unable to extubate the patient at the end of the case, what will you do? Are you
liable for a malpractice claim?
Assuming you have done the consent process properly, you will already
know the answer to this question for this patient! In a critically ill patient
undergoing abdominal surgery, there is a chance that postoperative intubation
and ventilation may be required; your consent procedure should
acknowledge this fact and a plan for what to do in this event should be
made in advance. Some authorities believe that the operating room is a
particularly difficult place for death to occur because surgeons and anesthesiologists
routinely intervene aggressively. “Resuscitation” is what we do
for a living! Therefore, some have argued, a decision to extubate or discontinue
ventilation might be better made in the ICU than the OR, if for no
other reason that the patient’s family can be present and participate in the
decision-making.
Malpractice claims arise when a physician breaches a duty to a patient
and causes harm. Although there is no guarantee that any given situation
will not lead to a lawsuit, the mere fact that you are unable to extubate
should not constitute malpractice unless you have not adequately counseled
the patient and obtained informed consent.
Suggested Further Reading
Beauchamp TL, Childress JF (2001) Principles of biomedical ethics.
Oxford University Press, New York
Studdert DM et al (2006) Claims, errors, and compensation payments in medical
malpractice litigation. N Engl J Med 354:2024–2033
Drane JF (1984) Competency to give an informed consent. A model for making
clinical assessments. JAMA 252:925–927