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The dangers of oversedation for pain management, other office surgical procedures

Oversedation, poor carbon dioxide monitoring have been linked to brain injuries and deaths

Recent medical research and malpractice claims history have shown that unnecessary use of sedation and oversedation have become serious problems for the safety of surgical patients.

The most common factors leading to severe anoxic/hypoxic brain injuries or death include:

• Failure to follow the standard of care, as evidenced by peer-reviewed recommendations and guidelines

• The use of deep sedation when it’s not necessary

• A physician anesthesiologist isn’t involved in supervising or directing anesthesia

• Failure to monitor adequately, including ventilation and continuous end-tidal carbon dioxide (CO2)

Additionally, in many anesthesia malpractice cases, patients are in a prone (stomach down/back up) position, which makes monitoring more difficult. It’s not necessarily negligent to place the patient in a prone position, but it’s something that should be considered.

If a prone patient needs to be resuscitated, first the surgery has to stop and the patient needs to be repositioned.

Oversedation

Guidelines of the American Society for Anesthesiologists (ASA) require an anesthesiologist physician to perform a pre-anesthesia evaluation on patients. The overall purpose of the pre-anesthesia evaluation is for the anesthesiologist to determine if it’s safe to proceed with the surgery or procedure and, if so, under what level of sedation or anesthesia.

Certified registered nurse anesthetists (CRNAs), who are not physicians, are increasingly providing anesthesia care with less, or even absent, supervision by an anesthesiologist. When this occurs, it’s up to the CRNA to perform the pre-anesthesia evaluation.

Some surgeons and physicians prefer to have their patients sedated for procedures, even when it’s not medically necessary. And some anesthesia providers go along with it. That creates an unnecessary risk to patient safety.

Interventional pain procedures

With so many advances in pain management, more and more patients receive interventional pain procedures or surgeries.

The American Society of Anesthesiologists Committee on Pain Medicine has long advised caution when it comes to using moderate (conscious) sedation or anesthesia during pain surgery for procedures. As with any use of anesthesia care, there must be a balance of benefit and risk.

In many interventional pain procedures, it’s appropriate to perform them with only local anesthesia. These procedures include:

• Epidural steroid injections

• Epidural blood patch

• Trigger point injections

• Shoulder, hip, knee, facet and sacroiliac joint injections

• Occipital nerve blocks

The standard of care requires avoiding oversedation. When the anesthesia provider determines that moderate (conscious) sedation is safe and appropriate for patient and interventional pain procedure, the goal is to keep the patient awake enough to be responsive—able to answer questions and give verbal feedback—during key portions of the pain procedure.

This feedback is critical to patient safety because only the patient can provide information about pain intensity or abnormalities that come up during the procedure, including identification of painful stimuli during the procedure that’s important to avoid spinal cord trauma.

In 2019, the American Society of Interventional Pain Physicians published a guideline stating that it was not recommended or appropriate to use propofol for interventional pain procedures. The reason is that propofol (the Michael Jackson/Joan Rivers anesthetic that’s widely used in operating rooms) is potent and can result in rapid deep sedation and/or general anesthesia states, which makes the patient unable to communicate.

Poor monitoring during sedation

In many anesthesia medical malpractice cases that I’ve handled, the defense focuses on oxygen saturation. An excellent anesthesiology expert that I retained in Dallas explained in her deposition how the more important factor for patient well-being is ventilation, which is the exchange of air.

We all know from basic science that respiration involves absorption of oxygen and elimination of carbon dioxide. That’s ventilation.

The standard of care requires anesthesia providers to monitor carbon dioxide (CO2), through continuous end-tidal CO2 monitoring. The failure to do so has been shown to result in unnecessary deaths and serious injuries because of delays in responding to inadequate ventilation (hypoventilation), development of respiratory acidosis (buildup of carbon dioxide in the blood), and eventual cardiac arrest and anoxic (absence of oxygen) brain injury.

If you or someone you care for has been seriously injured because of oversedation in Texas, then contact a top-rated experienced Texas medical malpractice lawyer for free consultation about your case.

Robert Painter is an award-winning medical malpractice attorney at Painter Law Firm PLLC, in Houston, Texas. He is a former hospital administrator who represents patients and family members in medical negligence and wrongful death lawsuits all over Texas. Contact him by calling 281-580-8800 or emailing him right now.


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