Intubation, extubation, and anesthesia medical malpractice

As a Houston, Texas medical malpractice attorney, I’ve handled a lot of cases and lawsuits involving mistakes by anesthesiologists and certified registered nurse anesthesiologists (CRNAs).

There are a handful of common issues that I see over and over again in anesthesia cases. Some involve the anesthesia provider going through the motions before a procedure, rather than doing a comprehensive pre-anesthesia evaluation to identify and prepare for any areas of concern. Other cases arise from a patient going into cardiac or respiratory arrest while under general anesthesia and the anesthesia providers don’t initiate and manage a proper resuscitation.

Today, though, I’m writing about another common issue in anesthesia cases: improper intubation.

What are intubation and extubation?

As the name suggests intubation is the process where a breathing (endotracheal) tube is inserted down a patient’s windpipe (trachea). By the way, extubation is where the breathing tube is removed.

Intubation may be done at any time when healthcare providers think a patient’s airway is compromised. It’s the most efficient way to restore critical oxygen flow to the patient.

When patients are placed under general anesthesia for surgery, anesthesia providers perform intubation because the powerful anesthetic medications paralyze muscles in the body, including the diaphragm, making it tough to breathe. Another risk is that the muscles of the airway relax under general anesthesia, which means the patient could aspirate food or liquids into the lungs, causing big problems.

Complications and medical malpractice

Misintubation, or improperly placing the endotracheal tube, is a most common intubation error that patients or family members in a wrongful death case come to see me about.

I handled a case a few years ago, for example, where the anesthesiologist put the tube down a patient’s throat, rather than the windpipe. The patient ended up with a brain injury because of a lack of oxygen.

Other intubation errors include improper placement in the windpipe or airway itself, damaging nerves in the neck while placing the tube, delays in intubation, under- or over-inflating with the anesthesia breathing machine, and not connecting the breathing tube correctly.

When these mistakes occur, there’s very limited time for the anesthesiologist or CRNA to correct them. While a provider who did a proper pre-anesthesia evaluation should be prepared to handle an emergency, in many cases it seems like the anesthesia provider goes into a panic mode. Either way, if they can’t restore proper airflow quickly, the patient can develop a brain injury, go into a coma, have a stroke, or even die from cardiac or respiratory arrest.

There are also risks with extubation.

When patients are extubated, it’s important for the anesthesiologist, CRNA, surgeon, and nursing staff to keep an eye out for any unusual behavior. Telltale signs of a breathing problem include combativeness or thrashing around. I’m working on a wrongful death medical malpractice case now where a man in his 30s had a shoulder surgery at an outpatient surgery center. When the anesthesia provider extubated him, he became combative, but the healthcare team proceeded to wheel him out of the operating room. He died from the complications of respiratory arrest.

In many cases, these anesthesia, intubation, and extubation problems and deaths could have been avoided if the anesthesia providers planned ahead and responded appropriately when an emergency arose. From my experience in handling cases like this, I know what to look for in evaluating if there’s an anesthesia malpractice case.

We are here to help

Have you or someone you care for been seriously injured because of a medical error? If so, the experienced attorneys at Painter Law Firm are here to help. Click here to send us a confidential email via our “Contact Us” form or call us at 281-580-8800.

For medical malpractice matters, all consultations are free, and, because we only represent clients on a contingency fee, you will owe us nothing unless we win your case. We handle cases in the Houston area and all over Texas. We are currently working on medical malpractice lawsuits in Houston, The Woodlands, Sugar Land, Conroe, Dallas, Austin, San Antonio, Corpus Christi, Bryan/College Station, and Waco.


Robert Painter is a 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 against hospitals, physicians, surgeons, anesthesiologists, and other healthcare providers. A member of the board of directors of the Houston Bar Association, he was honored, in 2018, by H Texas as one of Houston’s top lawyers. Also, in 2018, the Better Business Bureau recognized Painter Law Firm PLLC with its Award of Distinction.

Robert Painter
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Robert Painter

Robert Painter is an award-winning medical malpractice attorney at Painter Law Firm Medical Malpractice Attorneys 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 for a free consultation and strategy session by calling 281-580-8800 or emailing him right now.