Anesthesia is an important part of many medical procedures, especially surgery. While most uses of anesthesia remain uneventful, accidents or mistakes may occur in rare cases, ranging from failing to understand a patient’s medical history to improperly administering anesthesia during a procedure 1. These can result in a wide range of injuries 2. Unintended injuries during anesthesia may be relatively minor, such as tooth damage caused by the breathing tube used during general anesthesia, or be as severe as brain damage caused by too little oxygen.
Tooth injuries are the most common type of injury to occur during anesthesia. One of the most important jobs of an anesthesiologist is to intubate a patient, i.e. insert a tube down the trachea so the patient continues breathing. When intubation is improperly performed, the tube can chip or damage a patient’s tooth. While this may not be a serious health risk, it remains an injury for which an anesthesiologist and their hospital can be liable given that it can result in choking or other complications.
Nerve damage is one of the potential injuries associated with anesthesia. This includes physical nerve damage that can stem from failing to properly move and position a patient throughout surgery, placing excess strain on certain parts of their body. If the wrong anesthesia is used, or improper amounts are administered, nerve damage can be severe.
Organ damage, including in the form of cardiac arrest, can result from improper anesthesia too, or if complications related to the procedure occur. For example, if the wrong type of anesthesia is used and an adverse reaction occurs, organ damage can result in the worst cases.
One of the most disconcerting events can be the experience of awareness and/or pain during surgery, which can be the case if an inadequate amount of anesthesia is administered to the patient. In rare cases, a patient may experience “anesthesia awareness,” in which they become conscious intraoperatively and are aware of what is happening to them, although without being able to move or react. This can yield post-traumatic stress disorders, sleep disorders, or other psychological issues.
Improper anesthesia during an operation can also be lethal. Administering too high a dose of anesthesia can result in a coma or death. During surgery, the anesthesiologist is responsible for monitoring oxygen levels in a patient’s blood, but if this is not carried out, the patient can end up dying due to lack of oxygen. Permanent brain damage can further result if a patient’s oxygen levels remain too low during surgery. Death can also occur as a result of other complications that develop during surgery and are not properly identified.
Estimates of anesthesia-associated mortality in the second half of the 20th century have ranged from 1 in 415 to 1 in 6158 1. Anesthesia-related mortality has fallen from 6.4 in 10,000 in the 1940s to 4 in 1 million today, however, largely thanks to the introduction of safety standards and improved training. This said, the current figure of 4 in 1 million applies to patients without major systemic disease – mortality is higher among patients with severe accompanying illnesses 3. On the whole, better anesthetic management has clearly played an important role in improving surgical outcomes in recent years 3.
Further progress can still be made in reducing the incidence of injuries during anesthesia. Additional research on these problems will continue to help minimize their recurrence 4. In addition, all clinicians should remain cognizant of the fact that the safety of patients does not solely depend on the application of standards of practice, new equipment, or the use of new monitoring techniques. Safety can be maximized by combining modern technology with advances in education, training, supervision, standards of clinical practice, and vigilance.
1. Aitkenhead, A. R. Injuries associated with anaesthesia. A global perspective. BJA Br. J. Anaesth. 95, 95–109 (2005). doi: 10.1093/bja/aei132.
2. Runciman, W. B., Sellen, A., WEBBt, R. K., WILLIAMSONt, A. & CURRIEtt, M. Errors, Incidents and Accidents in Anaesthetic Practice. Anaesth Intens Care 21, 506–519 (1993).
3. Gottschalk, A., Van Aken, H., Zenz, M. & Standl, T. Is Anesthesia Dangerous? Dtsch. Arztebl. Int. 108, 469 (2011). doi: 10.3238/arztebl.2011.0469.
4. Gautam, B. & Shrestha, B. R. Critical Incidents during Anesthesia and Early Post-Anesthetic Period: A Descriptive Cross-sectional Study. JNMA J. Nepal Med. Assoc. 58, 240 (2020). doi: 10.31729/jnma.4821